RESUMO
OBJETIVO: Evaluar la efectividad de asociar una intervención educativa breve al tratamiento farmacológico para el insomnio en atención primaria (AP). DISEÑO: Ensayo clínico no aleatorizado simple ciego. Emplazamiento: Dos centros de salud urbanos en Gijón (Asturias). Participantes: Pacientes que consultaron por insomnio entre julio de 2012 y enero de 2013 y cumplieron criterios de inclusión. Fueron asignados sistemáticamente al grupo intervención (GI) o al grupo control (GC) tras aleatorizar al primer paciente de cada grupo. Todos iniciaron lorazepam 1 mg nocturno y acudieron a 4 visitas de 15 min y una visita de revisión al mes siguiente. Intervención: El GI fue instruido en medidas de control de estímulos, higiene del sueño y técnicas de relajación y respiración. Al GC se le hicieron mediciones no invasivas. Mediciones principales: Se consideró curados a quienes obtuvieron Índice de Calidad de Sueño de Pittsburg (ICSP) < 6 o reducción del 50%. Se analizó secundariamente el descenso del ICSP tras las visitas (visita final) y al mes siguiente (visita revisión), y consumo de lorazepam en la visita revisión. Análisis: inferencia bayesiana. RESULTADOS: Se obtuvieron 12 curaciones entre 26 intervenidos, y una entre 24 controles. Las medias posteriores del descenso de ICSP en visita final y revisión fueron de: -4,7 (ICred95%: -5,9 a -3,5) y -6,3 (ICred95%: -7,5 a -5,1) en GI, frente a -1,8 (ICred95%: -3 a -0,5) y -1,7 (ICred95%: -2,9 a -0,4) en GC. Abandonaron lorazepam 9 intervenidos (34,6%) frente a 4 controles (16,7%). Completaron el estudio 19 intervenidos y 17 controles. El análisis por protocolo no mostró diferencias relevantes. CONCLUSIONES: Implementar una intervención educativa breve en AP mejora la calidad del sueño y potencia una menor prescripción de benzodiacepinas
OBJECTIVE: To evaluate the effectiveness of providing an educational intervention in primary care (PC) alongside a pharmacological treatment for insomnia. DESIGN: Single blinded non randomised clinical trial. Location: Two urban primary health centers in Gijón (Asturias, Spain). Participants: Patients who consulted for insomnia between July 2012-January 2013 and met the inclusion criteria (n = 50) were assigned systematically to the control group (CG) or intervention group (IG). All patients initiated treatment with lorazepam 1 mg in the evenings and had four weekly 15 min visits plus a follow-up visit after another month. Interventions: The IG received training for control of stimuli, sleep hygiene and respiration and relaxation techniques in the four visits. The CG had only non invasive measures taken. Measurements: Considering as cured those who reached a Pittsburgh Sleep Quality Index PSQI < 6 or a 50% reduction from baseline level. It was also analyzed the change in the PSQI from baseline to final visit and to follow-up visit, and voluntary interruption of lorazepam. Analysis by Bayesian inference. RESULTS: Twelve out of recoveries after intervention against one out of 24 among control group. Mean change in PSQI to final visit and follow-up visit was: -4.7 (95%CrI: -5.9 to -3.5) and -6,3 (95%ICred: -7.5 to -5.1) in IG; -1.8 (95%ICred: -3 to -0.5) and -1.7 (95%ICred: -2.9 to -0.4) in CG. Interruption of lorazepan: in 4 controls (16,7%) and 9 (34,6%) in IG. Twenty nine patients in GI and 17 in GC completed the trial. Per protocol analysis showed similar results. CONCLUSIONS: The educational intervention in PC improves sleep quality and reduces the need of treatment with benzodiacepines
Assuntos
Humanos , Distúrbios do Início e da Manutenção do Sono/terapia , Educação em Saúde/métodos , Avaliação de Resultado de Intervenções Terapêuticas , Atenção Primária à Saúde/métodos , Teorema de Bayes , Benzodiazepinas/uso terapêuticoRESUMO
OBJETIVE: To evaluate the effectiveness of providing an educational intervention in primary care (PC) alongside a pharmacological treatment for insomnia. DESIGN: Single blinded non randomised clinical trial. LOCATION: Two urban primary health centers in Gijón (Asturias, Spain). PARTICIPANTS: Patients who consulted for insomnia between July 2012-January 2013 and met the inclusion criteria (n=50) were assigned systematically to the control group (CG) or intervention group (IG). All patients initiated treatment with lorazepam 1mg in the evenings and had four weekly 15 min visits plus a follow-up visit after another month. INTERVENTIONS: The IG received training for control of stimuli, sleep hygiene and respiration and relaxation techniques in the four visits. The CG had only non invasive measures taken. MEASUREMENTS: Considering as cured those who reached a Pittsburgh Sleep Quality Index PSQI <6 or a 50% reduction from baseline level. It was also analyzed the change in the PSQI from baseline to final visit and to follow-up visit, and voluntary interruption of lorazepam. Analysis by Bayesian inference. RESULTS: Twelve out of recoveries after intervention against one out of 24 among control group. Mean change in PSQI to final visit and follow-up visit was: -4.7 (95%CrI:-5.9 to -3.5) and -6,3 (95%ICred: -7.5 to -5.1) in IG; -1.8 (95%ICred: -3 to -0.5) and -1.7 (95%ICred: -2.9 to -0.4) in CG. Interruption of lorazepan: in 4 controls (16,7%) and 9 (34,6%) in IG. Twenty nine patients in GI and 17 in GC completed the trial. Per protocol analysis showed similar results. CONCLUSIONS: The educational intervention in PC improves sleep quality and reduces the need of treatment with benzodiacepines.
