Authors (including presenting author) :
Wong CW(1), Fok PA(1), Chu LS(1)
Affiliation :
Family Medicine Clinic, Caritas Medical Centre
Introduction :
Sleep disturbance is a common presenting problem at primary care. Management strategies however tend to be variable and highly individualized.
Objectives :
To understand the demographics of patients presenting with sleep problems to primary care To understand the comorbidities (if any) of patients presenting with sleep disturbance
To delineate the common management strategies of both new and existing cases of patients presenting with sleep disturbance
To identify areas for potential improvement of management for sleep disturbance
Methodology :
Clinical notes of all patients encountered at Family Medicine Clinic at Caritas Medical Centre between the 6 month interval of Aug 2017 to Jan 2018 were reviewed retrospectively. Both initial visits and subsequent visits that fall within this time period were included.
Patients were included only if primary care clinic was the place of first encounter for their sleep problems. Patients who were initially seen by other specialties for their sleep problems, or those who were currently receiving follow-up/have defaulted follow-up at other specialties for their sleep problems were excluded.
Result & Outcome :
91 patients presented with sleep disturbance over the specified 6-month period. Majority (>80%) of patients were above 50 years old. About 60% of the patients were female. One-third of patients have been followed-up at clinic for >2 years
About 40% (n=35) of patients with sleep disturbance had medical/psychiatric comorbidities. The most common medical comorbidity was thyroid conditions. The most common psychiatric comorbidity was depression/dysthymia
Pharmacological treatment were offered in over 80% (n=75) of patients. It was the only form of treatment given for 73% (n=55) of patients amongst the group. The most commonly used drug was promethazine. Non-pharmacological approach including sleep hygiene were offered in 28% (n=26) patients only. New patients were less likely to receive drug treatment than patients who came for subsequent visits. Around 50% (n=42) of patients were offered referral to other services including Integrated Mental Health Programme or Psychiatry. Over 70% (n=31) of them accepted referral. Comments: Non-pharmacological therapies are widely regarded as an integral part of treatment of primary and secondary sleep disturbance^. There is certainly room to increase such practice, given that it has only been offered to 28% of our patients. Further studies on staff awareness, staff competencies and clinical feasibilities are needed to facilitate adaptation of this practice. ^Reference
Riemann, Dieter, et al. "European guideline for the diagnosis and treatment of insomnia." Journal of sleep research 26.6 (2017): 675-700.
Schutte-Rodin, Sharon, et al. "Clinical guideline for the evaluation and management of chronic insomnia in adults." Journal of Clinical Sleep Medicine 4.05 (2008): 487-504.
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