델파이 기법을 이용한 다빈도 수면진정제 안전사용지침 개발
Development of Safety Usage Guidelines for Sedative Hypnotics Using the Delphi Technique
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목 적：본 연구는 대한수면의학회로부터 수면에 대한전문가로 구성된 집단을 모집하여 델파이 기법을 통해 수면진정제의 안전사용지침을 개발하고자 한다. 방 법：대한수면의학회 소속 수면 전문가 15인을 모집하였으며, 전문가들을 대상으로 웹 기반의 3차 델파이 조사를 시행하였다. 첫 델파이 조사는 39개의 문항으로 구성되었으며 한국에서 수면진정제 사용의 문제점을 환기하고, 안전사용지침에 포함되어야 할 항목들에 대한 조사를 시행하였다. 두번째 델파이 조사는 21개의 문항으로 구성되었으며 수면진정제 처방에 있어서 임상적으로 중요한 문제들에 대한 구체적인 의견을 수집하였다. 세번째 델파이 조사는 Likert 척도를 이용하여 1, 2차 조사를 통해 도출한 수면진정제 안전사용지침에 대한 의견 동의율을 구하고 이를 바탕으로 수면진정제 안전사용지침을 개발하였다. 결 과：17개 항목에 대한 전문가들의 의견 동의율이 중앙값 4점 이상이었으며 평균 4.12, 표준편차 0.32를 보였다. 본 연구를 통해 개발된 수면진정제 안전사용지침은 수면진정제의 처방, 유지, 그리고 감량 및 중단에 대한 총 13개의 지침을 제안한다. 결 론：증가하는 불면증 환자와 수면진정제 처방에도 불구하고 한국 임상 현실에 맞는 안전사용지침이 부재하였는데, 본 연구를 통해 개발된 수면진정제 안전사용지침을 통해 한국 임상에서 수면 비전문가들이 수면진정제를 처방할 시에 안전하고 효과적인 처방을 위해 유용하게 사용될 수 있을 것이다.
Abstract
Objectives: The objective of this study was to develop evidence- and consensus-based clinical safety usage guidelines for sedative hypnotics using the Delphi technique. Methods: A group of 15 sleep experts from Korean Academy of Sleep Medicine were chosen for this study comprising a three-round web-based Delphi survey. The first round survey was composed of 39 questions to identify problems with sedative hypnotics usage in Korean clinical practice and the result roughly outlined what should be included in the guidelines. The second round survey was composed of 21 questions to collect specific opinions of experts on clinically important issues in prescribing sedative hypnotics, and its result provided the basis for the guidelines. A third round survey aimed to evaluate the reliability and validity of the established guidelines. Results: In the third round, all 17 items showed a median of 4 or more, with an average of 4.12 and a standard deviation of 0.32. Thus we present safety usage guidelines with 13 propositions for prescription, maintenance, and withdrawal of sedative hypnotics. Conclusion: The safety usage guidelines on sedative hypnotics developed from this study could lead to safe and effective prescription of hypnotics in clinical practice, especially for the non-experts in sleep medicine. Furthermore, the guidelines will help to improve the quality of insomnia treatment by contributing to the establishment of a safe regime for sedative hypnotics without excessive use of drugs.
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