Implementation of a digital cognitive behavioral therapy for insomnia pathway in primary care.

Jun 17, 2021

Contributor: Alexander Sweetman,Anton Knieriemen,Elizabeth Hoon,Oliver Frank,Nigel Stocks,Andrea Natsky,Billingsley Kaambwa,Andrew Vakulin,Nicole Lovato,Robert Adams,Leon Lack,Christopher B Miller,Colin A Espie,R Doug McEvoy

Implementation of a digital cognitive behavioral therapy for insomnia pathway in primary care.

Background Insomnia is a prevalent and debilitating disorder commonly managed by family physicians. Insomnia guidelines recommend cognitive behavioral therapy for insomnia (CBTi) as the ‘first-line’ treatment. However, family physicians report limited time, knowledge, access, support, and referral options to manage patients with CBTi. Consequently, many patients with insomnia are prescribed potentially harmful and addictive sedative-hypnotic medicines (e.g. benzodiazepines). Family physicians require an insomnia management pathway that is specifically tailored to the guideline-recommendations, time demands, and capacity of family practice. Methods This mixed-methods implementation trial will test the feasibility, acceptability and effectiveness of a comprehensive digital insomnia management pathway in family practice. This novel pathway includes digital recruitment of family physicians, automatic identification of patients whose electronic medical records contain recent sedative-hypnotic prescriptions using a software management pathway and real-time notifications prompting physicians to refer patients to a well-established digital CBTi program. At least 10 family physicians and 375 patients with insomnia will be recruited. Physicians will be provided with an eBook to guide gradual sedative-hypnotic withdrawal. Feasibility and acceptability will be assessed from the perspective of patients and physicians. Effectiveness will be determined by co-primary outcomes: cessation of sedative-hypnotic use, and improvement in self-reported insomnia symptoms from baseline to 12-month follow-up. Analysis of trends in costs, cost-effectiveness and cost-utility analyses will be conducted from a societal perspective. Results and discussion This implementation trial will pave the way for future scaling-up of this insomnia management pathway to improve access to CBTi and reduce reliance on sedative-hypnotic medicines in family practice. Trial Registration: This trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12619001539123).
Copyright © 2018. Published by Elsevier Inc.

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About The Expert

Alexander Sweetman

The Adelaide Institute for Sleep Health, A Centre of Research Excellence and Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia. Electronic address: alexander.sweetman@flinders.edu.au.

Anton Knieriemen

East Bentleigh Medical Group, Bentleigh East, Victoria, Australia; Doctors Control Panel Pty Ltd, Australia.

Elizabeth Hoon

National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia; Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia.

Oliver Frank

National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia; Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia.

Nigel Stocks

National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia; Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia.

Andrea Natsky

National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia; Health Economics, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

Billingsley Kaambwa

National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia; Health Economics, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

Andrew Vakulin

The Adelaide Institute for Sleep Health, A Centre of Research Excellence and Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.

Nicole Lovato

The Adelaide Institute for Sleep Health, A Centre of Research Excellence and Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.

Robert Adams

The Adelaide Institute for Sleep Health, A Centre of Research Excellence and Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.

Leon Lack

The Adelaide Institute for Sleep Health, A Centre of Research Excellence and Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia; College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.

Christopher B Miller

Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc., San Francisco, USA; Big Health Inc., London, UK.

Colin A Espie

Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc., San Francisco, USA; Big Health Inc., London, UK.

R Doug McEvoy

The Adelaide Institute for Sleep Health, A Centre of Research Excellence and Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.

References

PubMed