Treating insomnia in Swiss primary care practices: A survey study based on case vignettes

Abstract

Guidelines recommend cognitive behavioural therapy for insomnia (CBT‐I) as first‐line treatment for chronic insomnia, but it is not clear how many primary care physicians (PCPs) in Switzerland prescribe this treatment. We created a survey that asked PCPs how they would treat chronic insomnia and how much they knew about CBT‐I. The survey included two case vignettes that described patients with chronic insomnia, one with and one without comorbid depression. PCPs also answered general questions about treating chronic insomnia and about CBT‐I and CBT‐I providers. Of the 820 Swiss PCPs we invited, 395 (48%) completed the survey (mean age 54 years; 70% male); 87% of PCPs prescribed sleep hygiene and 65% phytopharmaceuticals for the patient who had only chronic insomnia; 95% prescribed antidepressants for the patient who had comorbid depression. In each case, 20% of PCPs prescribed benzodiazepines or benzodiazepine receptor agonists, 8% prescribed CBT‐I, 68% said they knew little about CBT‐I, and 78% did not know a CBT‐I provider. In the clinical case vignettes, most PCPs treated chronic insomnia with phytopharmaceuticals and sleep hygiene despite their lack of efficacy, but PCPs rarely prescribed CBT‐I, felt they knew little about it, and usually knew no CBT‐I providers. PCPs need more information about the benefits of CBT‐I and local CBT‐I providers and dedicated initiatives to implement CBT‐I in order to reduce the number of patients who are prescribed ineffective or potentially harmful medications.

Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners

“…The findings of this study indicate a discrepancy between current clinical practice and the RACGP clinical guidelines which recommend CBTi as the first line treatment for insomnia [18]. GPs rely on sleep hygiene education treatment with scarce reference to the other components of CBTi, consistent with previous research on this topic [37][38][39][40]. This is of concern given limited evidence about the effectiveness of sleep hygiene as a standalone treatment in primary care [41].…”

Primary Care Management of Chronic Insomnia: A Qualitative Analysis of the Attitudes and Experiences of Australian General Practitioners

“…The ndings of this study indicate a discrepancy between current clinical practice and the RACGP clinical guidelines which recommend CBTi as the rst line treatment for insomnia (18). GPs rely on sleep hygiene education treatment with scarce reference to the other components of CBTi, consistent with previous research on this topic (37)(38)(39). This is of concern given limited evidence about the effectiveness of sleep hygiene as a standalone treatment in primary care (40).…”

Counselling for Chronic Insomnia in Swiss Pharmacies: A Survey Study Based on Case Vignettes

“…We conducted a structured online survey whose concept was based on a similar project aimed at PCPs and developed by Linder et al [ 17 ]. The survey was adapted to community pharmacists and separated into four different parts, comprising items on demographic data about the pharmacists and their pharmacy, questions to be answered about three clinical vignettes, general questions about insomnia and questions about the pharmacist’s broad knowledge of CBT-I.…”

“…Information about pharmacists’ knowledge of CBT-I is also lacking. Indeed, a vignette-based survey study of PCPs in Switzerland demonstrated their limited knowledge about CBT-I as well as discrepancies between the treatments they initiated and current guidelines [ 17 ]. Consequently, our hypothesis derived from these findings was, that most pharmacists in Switzerland would advise their clients to use phytopharmaceuticals alone or in combination with a non-pharmacological treatment other than CBT-I.…”