Diagnosis and treatment of outpatient insomnia by psychiatric and nonpsychiatric physicians

Insomnia is commonly encountered in general medical practice, but little is known about how primary care physicians manage this problem. We reviewed medical records describing 536 patient encounters in which either triazolam (Halcion) or flurazepam (Dalmane) was prescribed for outpatient use. Only 1...

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Bibliographic Details
Published in:The American journal of medicine Vol. 93; no. 1; p. 78
Main Authors: Shorr, R I, Bauwens, S F
Format: Journal Article
Language:English
Published: United States 01.07.1992
Subjects:
Disease
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Female
Flurazepam - administration & dosage
Flurazepam - therapeutic use
General Surgery
Humans
Internal Medicine - statistics & numerical data
Internship and Residency - statistics & numerical data
Male
Medical History Taking - statistics & numerical data
Mental Disorders - diagnosis
Mental Disorders - drug therapy
Physicians - statistics & numerical data
Practice Patterns, Physicians' - statistics & numerical data
Psychiatry - statistics & numerical data
Sex Factors
Sleep Initiation and Maintenance Disorders - diagnosis
Sleep Initiation and Maintenance Disorders - drug therapy
Triazolam - administration & dosage
Triazolam - therapeutic use
Wisconsin - epidemiology
Wisconsin
ISSN:0002-9343
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Summary:Insomnia is commonly encountered in general medical practice, but little is known about how primary care physicians manage this problem. We reviewed medical records describing 536 patient encounters in which either triazolam (Halcion) or flurazepam (Dalmane) was prescribed for outpatient use. Only 12% of the progress notes written by internists or surgeons contained even a remote reference to sleep, whereas 74% of psychiatrist's notes contained at least some sleep symptom documentation. In a multivariate analysis including the number of medical and psychiatric diagnoses, patient age, and physician gender, only the prescriber department was independently associated with the presence of symptom documentation. We also found that 30% of the prescriptions written by internists or surgeons were for inappropriately large quantities of these drugs (180 or more doses) compared with 6% of the prescriptions written by psychiatrists. We conclude that the evaluation of insomnia by nonpsychiatrists is often incomplete and that hypnotic drugs may be inappropriately prescribed by these physicians. Further efforts are needed to improve the management of insomnia by primary care physicians in the outpatient setting.
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ISSN:0002-9343
DOI:10.1016/0002-9343(92)90683-3