Table 1 Studies of general practitioners: measures and outcomes relating to insomnia

Orr et al. (1980) [37]

United States

378 Physicians attending a course on sleep disorders

Examination of popular misconceptions of sleep (20 Questions)

Physicians scored below chance suggesting a greater need for sleep medicine education as part of training.

Skills

Hohagen et al. (1993) [38]

Germany

2512 patients attending 10 general practitioners

Questionnaire at 3 time points: baseline (T1), 4 months later (T2), 2-years later (T3), included DSM criteria

In 8.8% of cases of mild insomnia, 21.9% of cases of moderate insomnia and 39.2% of cases of severe insomnia the GP was aware of a sleep problem. 5% of insomnia cases were diagnosed without the patient reporting a sleep problem in the questionnaire.

Knowledge, Skills

Hohagen et al. (1994) [39]

Germany

330 older adults (aged 65+) attending 5 general practitioner clinics

DSM-III-R criteria

In 18% of cases of mild insomnia, 31% of cases of moderate insomnia and in 52% of cases of severe insomnia the GP was aware of a sleep problem. 14% of insomnia cases were diagnosed without the patient reporting a sleep problem in the questionnaire.

Knowledge, Skills

Haponik et al. (1996) [40]

United States

20 experienced primary care practitioners, 23 uninstructed medical interns and 22 interns with instruction on sleep medicine

Frequency of sleep history recorded during encounters with simulated patients (30 min consultations)

Interns who had received instruction in sleep medicine more often asked about sleep (81.8%), but uninstructed interns (13%) and physicians (0%) did not record sleep history during consultation.

Knowledge, Belief about capability

Papp et al. (2002) [41]

United States (Northeast Ohio)

105 physicians

Structured survey on attitudes and knowledge of sleep disorders

Physicians rated their knowledge of sleep disorders as ‘fair’ (60%) and ‘poor’ (30%). Only 10% rated their knowledge as good, and 0% rated it as excellent.

Knowledge, Skills, Professional Role and Identity,

Greatest influence on changing practice style regarding sleep were journal articles followed by continuing education, followed by discussion with specialists.

Siriwardena et al. (2010) [42]

United Kingdom (Lincolnshire, rural cohort)

Cross-sectional study of GPs (n = 84)

Prescribing preferences of GPs for insomnia vs anxiety diagnoses

For insomnia, GPs were more likely to favour giving advice on sleep hygiene and prescribing a hypnotic (Z-drugs favoured over benzodiazepines). For anxiety, referral to a psychologist/mental health worker was favoured.

Beliefs about capabilities, Environmental context and resources

Preference to reduce use of drugs for insomnia but GPs felt insufficient resources or alternative management strategies were available

Hassed et al. (2012) [22]

Australia, Melbourne (metropolitan sample)

15 General Practitioners

Focus groups (n = 7) and face-to-face interviews (n = 8). DSKQ

Scores from DSQK suggested gaps in knowledge related to defining the underlying cause and correct treatment options.

Knowledge, Skills, Environmental context and resources

Behavioural intervention were viewed as preferable to prescribing medication.

Barriers to knowledge identified: limited training, lack of resources, patient expectation to receive a pill, consultation time constraint.

Cheung et al. (2014) [43]

Australia, Sydney (metropolitan sample)

GPs (n = 8) Pharmacists (n = 14)

Semi-structured interview from a convenience sample. Data analysed using a framework analysis

Practitioners perceived an overreliance on pharmacotherapy and inadequate support to direct patients to alternate pathways.

Environmental context and resources

Patients often have a reliance or expectation of a ‘quick fix’.

Conroy & Ebben (2015) [44]

University of Michigan Hospitals and Weill Cornell Medical College of Cornell University.

Physicians (n = 239)

Questionnaire –mailed out

Most physicians did not nominate CBTi or a hypnotic as the most effective treatment for insomnia.

Knowledge, Skills

1/3 recommended sleep hygiene.

N = 22 felt CBTi alone was effective.

Davy et al., (2015) [45]

Primary care in Nottinghamshire and Lincolnshire.

Health professionals (n = 23), and patients with insomnia (n = 28)

Focus groups, and interviews

Practitioners tended to focus on sleep hygiene rather than CBTi.

Knowledge, Skills, Behavioural Regulation

Some practitioners felt they colluded with patients when prescribing hypnotics.

Patients often ignored sleep hygiene advice, and sometimes took hypnotics as not intended

Both practitioners and patients wanted more options and better training