醫師的安眠藥物處方行為之初探: 一項質性研究

Objectives: In Taiwan, the bulk of studies about hypnotics have focused on the content of prescriptions, with relatively less emphasis on the physician's clinical considerations. The objective of this study was to explore hypnotic prescribing behavior by physicians. Methods: Referred by friends engaged in medical work, 17 physicians who prescribed hypnotics consented to in-depth interviews. Data were subject to editing style analysis. Results: Factors influencing hypnotic prescribing behavior included physician specialization, patient expectation of drug effects, maintenance of social functioning of the patient, and the doctor-patient relationship. The physician might not want to respond to a patient's request, but the long-term doctor-patient relationship might still influence prescription behavior and the physician would prescribe the same drug again. If the patient were a first-time user, the physician would prescribe benzodiazepine receptor agonists. Because of confidence in non-benzodiazepine drugs, physicians would ignore the risk of using these drugs. Some physicians believed that patients did not want to get too many messages, and told their patients only the name of the medication and the time of ingestion, but not a detailed description of the effects or the need for continuous follow-up evaluation and consultation. Other than their impact on the health care payment system, most of the physicians had limited knowledge about non-pharmaceutical treatments for insomnia. As a result, the treatment of insomnia still heavily relies on prescription medications. Conclusions: Based on the results, we suggest that the government might adopt pay for performance to cover the cost of alternative medical treatments. To reduce the unnecessary use of hypnotics, physicians are encouraged to learn about other non-pharmaceutical techniques during continuing medication education, apply these techniques in clinical settings, and create proper treatment plans for patients with insomnia.