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


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          Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice.


          A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis. 


          Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited. 


          General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice.

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          Most cited references40

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          Using thematic analysis in psychology

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            Saturation in qualitative research: exploring its conceptualization and operationalization

            Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation—as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.
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              Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians.

              The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of chronic insomnia disorder in adults.

                Author and article information

                BMC Fam Pract
                BMC Fam Pract
                BMC Family Practice
                BioMed Central (London )
                22 July 2021
                22 July 2021
                : 22
                : 158
                [1 ]National Centre for Sleep Health Services Research, Adelaide, Australia
                [2 ]GRID grid.1014.4, ISNI 0000 0004 0367 2697, FHMRI Sleep Health/Adelaide Institute for Sleep Health, College of Medicine and Public Health, , Flinders University, ; Adelaide, Australia
                [3 ]GRID grid.474225.2, ISNI 0000 0004 0601 4585, Sax Institute, ; Sydney, Australia
                [4 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Faculty of Medicine and Health, , University of Sydney, ; Sydney, Australia
                [5 ]GRID grid.1014.4, ISNI 0000 0004 0367 2697, College of Education, Psychology and Social Work, , Flinders University, ; Adelaide, Australia
                [6 ]GRID grid.1033.1, ISNI 0000 0004 0405 3820, Faculty of Health Sciences & Medicine, , Bond University, ; Queensland Robina, Australia
                [7 ]GRID grid.1010.0, ISNI 0000 0004 1936 7304, Discipline of General Practice, , University of Adelaide, ; Adelaide, Australia
                [8 ]GRID grid.467022.5, ISNI 0000 0004 0540 1022, Southern Adelaide Local Health Network, SA Health, ; Adelaide, Australia
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                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                : 2 December 2020
                : 20 April 2021
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                © The Author(s) 2021

                insomnia,sleep,primary care,general practitioners,general practice,family practice,australia,qualitative research


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