title: Utilization of psychotropic drugs by patients consulting for sleeping disorders in homeopathic and conventional primary care settings: the EPI3 cohort study.
abstract: BACKGROUND
  Utilization of sedative hypnotic drugs for sleeping disorders (SD) raises concerns, particularly among older people. This study compared utilization of conventional psychotropic drugs for SD among patients seeking care from general practitioners (GPs) who strictly prescribe conventional medications (GP-CM), regularly prescribe homeopathy in a mixed practice (GP-Mx), or are certified homeopathic GPs (GP-Ho).
  
  
  METHODS
  This was a French population-based cohort study of GPs and their patients consulting for SD, informed through the Pittsburgh sleep quality index (PSQI) questionnaire. Information on psychotropic drugs utilization was obtained from a standardized telephone interview at inclusion, one, three and 12 months.
  
  
  RESULTS
  346 patients consulting for SD were included. Patients in the GP-Ho group experienced more often severe SD (41.3%) than patients in the GP-CM group (24.3%). Adjusted multivariate analyses showed that patients who chose to be managed by GP-Ho were less likely to use psychotropic drugs over 12 months as opposed to the GP-CM group, with Odds ratio (OR) = 0.25; 95% confidence interval (CI): 0.14 to 0.42. Patients in the GP-Mx group also used less psychotropic drugs but the result was not statistically significant (OR = 0.67; 95% CI: 0.39-1.16). Rates of clinical improvement of the SD did not differ between groups.
  
  
  CONCLUSIONS
  Patients with SD who chose to consult GPs certified in homeopathy consumed less psychotropic drugs and had a similar evolution of their condition to patients treated with conventional medical management. This result may translate in a net advantage with reduction of adverse events related to psychotropic drugs.
authors.affiliation: LA-SER, 10 Place de Catalogne, 75014 Paris, France; Conservatoire national des arts et métiers (CNAM), 292 Rue Saint-Martin, 75003 Paris, France. Electronic address: Lamiae.Grimaldi@la-ser.com.
authors.forename: Lamiae
authors.initials: L
authors.lastname: Grimaldi-Bensouda
authors.affiliation: LA-SER Europe Limited, 66 Chiltern St, London W1U 4JT, United Kingdom; Department of Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom. Electronic address: lucien.abenhaim@gmail.com.
authors.forename: Lucien
authors.initials: L
authors.lastname: Abenhaim
authors.affiliation: Faculty of Medicine, University of Franche Comté, 9 Rue Ambroise Paré, 25000 Besançon, France. Electronic address: jacques.massol@univ-fcomte.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Massol
authors.affiliation: Pasteur Institute, 28 Rue du Docteur Roux, 75015 Paris, France; University of Paris-Ile de France Ouest, 9 Boulevard d'Alembert, 78280 Guyancourt, France. Electronic address: didier.guillemot@pasteur.fr.
authors.forename: Didier
authors.initials: D
authors.lastname: Guillemot
authors.affiliation: LA-SER, 10 Place de Catalogne, 75014 Paris, France. Electronic address: Bernard.Avouac@la-ser.com.
authors.forename: Bernard
authors.initials: B
authors.lastname: Avouac
authors.affiliation: Cyklad Group, 16 Rue André Le Nôtre, 69140 Rillieux-la-Pape, France. Electronic address: Gerard.Duru@gmail.com.
authors.forename: Gerard
authors.initials: G
authors.lastname: Duru
authors.affiliation: INSERM U1018, Centre for Epidemiology and Population Health, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif, France. Electronic address: france.lert@inserm.fr.
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.affiliation: Faculty of Medicine, University Pierre and Marie Curie, 4 Place Jussieu, 75005 Paris, France. Electronic address: AMMagnier@nerim.fr.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Magnier
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada. Electronic address: Michel.Rossignol@mcgill.ca.
authors.forename: Michel
authors.initials: M
authors.lastname: Rossignol
authors.affiliation: Sainte-Anne Hospital, University of Paris V René Descartes, 100 Rue de la Santé, 75674 Paris, France. Electronic address: F.Rouillon@ch-sainte-anne.fr.
authors.forename: Frederic
authors.initials: F
authors.lastname: Rouillon
authors.affiliation: INSERM U657, University of Bordeaux Segalen, 146 Rue Léo Saignat, 33076 Bordeaux, France. Electronic address: Bernard.Begaud@pharmaco.u-bordeaux2.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Begaud
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006705:Homeopathy / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: Homeopathy; Insomnia; Primary care