title: (Mis) perceptions and interactions of sleep specialists and generalists: obstacles to referrals to sleep specialists and the multidisciplinary team management of sleep disorders.
abstract: OBJECTIVE
  This study assessed generalists' perceptions and challenges in providing care to sleep disorders patients and the role of sleep specialists in improving gaps in care.
  
  
  METHODS
  A mixed-method approach included qualitative (semi-structured interviews, discussion groups) and quantitative (online surveys) data collection techniques regarding care of patients with obstructive sleep apnea (OSA) and shift work disorder (SWD).
  
  
  RESULTS
  
  
  
  METHODS
  OSA: generalists n = 165, specialists (internists, neurologists, psychiatrists, pulmonologists) n = 12; SWD: generalists n = 216, specialists n = 108. Generalists reported challenges in assessing sleep disorders and diagnosing patients with sleep complaints. Generalists lacked confidence (selected ≤ 3 on a 5-pt Likert scale) in managing polypharmacy and drug interactions (OSA: 54.2%; SWD: 62.6%), addiction (OSA: 61.8%), and continuous positive airway pressure (OSA: 66.5%). Generalists in both studies reported deficits in knowledge of monitoring sleep disorders (OSA: 57.7%; SWD: 78.7%), rather relying on patients' subjective reports; 23% of SWD generalists did not identify SWD as a medical condition. Challenges to generalist-specialist collaboration were reported, with 66% of generalists and 68% of specialists in the SWD study reporting lack of coordination as a barrier. Generalists reported lack of consistency in sleep medicine and a perceived lack of value in consulting with sleep specialists.
  
  
  CONCLUSIONS
  Knowledge and attitudinal challenges were found in primary care of patients with sleep disorders. Sleep specialists need to clarify and educate practitioners regarding primary care's approach.
authors.affiliation: AXDEV Group Inc., Quebec, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Hayes
authors.forename: Suzanne
authors.initials: S
authors.lastname: Murray
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Castriotta
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D002983:Clinical Competence; D058006:General Practice; D019538:Health Care Surveys; D006801:Humans; D007400:Interprofessional Relations; D010348:Patient Care Team; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012017:Referral and Consultation; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy*; D020178:Sleep Disorders, Circadian Rhythm / Q000175:diagnosis / Q000628:therapy*; D014481:United States