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Master Thesis

Étude de l’impact d’une formation à la prescription des hypnotiques sur les niveaux de prescription chez le sujet âgé

Abstract : Context: the elderly is a population particularly at risk of developing insomnia due to the development of frailty. Sleep disorders constitutes a geriatric syndrome to which practitioners must be aware. Optimizing medical knowledge and practices are essential in order to consider appropriate preventive and therapeutic measures. According to the latest European insomnia guidelines, the most effective treatment for insomnia is cognitive and behavioral therapy. However, this method of therapy is not used sufficiently and this to the detriment of an overuse of hypnotic drugs despite an unfavorable quality of sleep / adverse effects ratio on patients. The objective of this study is to observe the impact of the training on hypnotic prescriptions made by doctors who have received the training, in geriatric subjects in the management of insomnia.
Methods: the study was prospective, single-center, over a period of four months, with factual collection of important data on the practices of physicians via the computerized patient medical record. The study population consisted of all geriatric patients over the age of 70, hospitalized in several hospital departments of the university hospital center of Nice. Patients of the doctors who were absent at the training were excluded of the study. One week before training, the full data was collected with the characteristics of the population and their hypnotic prescriptions. One week after, the training was conducted on a total of 34 physicians on the management of insomnia and proper use of hypnotics on the elderly people. Then, we carried out the data collection at 15 days, one month and three months after the training date. The primary endpoint was to assess the change of the hypnotics prescription rate after the training on the correct prescribing of hypnotics. Comparison of prescription percentages one week before training, 15 days, one month and three months after training.
Results: 840 geriatric patients were included (232 before training and 608 after training). We observe a graphical drop in the hypnotics prescription rate (all classes combined) with a rate of 61.1% at two weeks after training, 56.3% at one month of training and 58.2% at three months after training against 67.2% of having a week before training. However this decrease is not statistically significant between the four periods. After training, there is a graphical decrease in the prescription of benzodiazepines and Z-drugs but here again this decrease is not statistically significant compared to the reference period before training.
Conclusion: after the training, the treatment of insomnia of elderly hospitalized patients was not changed: the benzodiazepines and Z-drugs were prescribed too often and for too long. There is a need to expand and promote access to cognitive behavioral therapy for the treatment of insomnia. The application of these recommendations should be re-evaluated in aging subjects on a regular basis, both in hospital and on an outpatient basis.
Document type :
Master Thesis
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Submitted on : Monday, May 17, 2021 - 2:38:46 PM
Last modification on : Friday, November 26, 2021 - 3:16:36 AM


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  • HAL Id : dumas-03227640, version 1


Akshay Narsy. Étude de l’impact d’une formation à la prescription des hypnotiques sur les niveaux de prescription chez le sujet âgé. Médecine humaine et pathologie. 2021. ⟨dumas-03227640⟩



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