Physician and patient determinants of pharmacologic treatment of sleep difficulties in outpatient settings in the United States.
OBJECTIVE
This study analyzed patient and physician characteristics associated with physicians' choice of medication treatment for sleep difficulties in a nationally representative sample of outpatient physician visits in the United States.


METHODS
Cross-sectional study of nationally representative survey data.


METHODS
Outpatient settings in the United States.


METHODS
Patients aged 18 years or older with sleep difficulty.


METHODS
None.


RESULTS
The National Ambulatory Medical Care Survey data from 1996 to 2001 were utilized. The study found that approximately 4.8 billion visits were made to outpatient physician offices in the United States, and 94.6 million of these were visits related to sleep difficulties. Visits by established patients, compared with visits by new patients, were associated with an increased prescription of some type of pharmacotherapy (odds ratio: 1.92, 95% confidence interval: 1.35-2.73). Patient visits with public insurance, as compared with private insurance, as a primary payer source were associated with increased benzodiazepine prescriptions among patients receiving pharmacotherapy (odds ratio: 1.66, 95% confidence interval: 1.13-2.45). Visits by patients aged 65 years and older, as compared with those by patients aged 18 to 34 (reference group)., had almost two times increased odds of being associated with a benzodiazepine prescription (odds ratio: 1.89, 95% confidence interval: 1.13-3.14) among patient visits receiving pharmacotherapy.


CONCLUSIONS
The results of this study indicate that several patient and physician characteristics influence physician prescribing of pharmacologic treatments for sleep difficulties. The study also finds variations in pharmaceutical treatment for sleep difficulties in outpatient settings in the United States.
Balkrishnan
Rajesh
R
Division of Pharmacy Practice and Administration, Ohio State University College of Pharmacy, Columbus, OH 43210, USA. balkrishnan.1@osu.edu
Rasu
Rafia S
RS
Rajagopalan
Rukmini
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001569:Benzodiazepines / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States
D001569:Benzodiazepines