Using eHealth to Expand Access to Cognitive Behavioral Therapy for Insomnia in Hispanic Primary Care Patients

利用电子健康扩大西班牙裔初级保健患者失眠认知行为治疗的可及性

• 批准号: 10457288
• 负责人: Carmela Alcantara
• 金额: $ 36.83万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10457288
• 关键词: Using; eHealth; Expand; Access; Cognitive

Over 30 million US adults and nearly 20% of primary care patients suffer from chronic insomnia. Chronic insomnia is associated with increased morbidity, mortality, and high economic costs, and thus represents a major public health problem. Importantly, the prevalence of insomnia is significantly higher in Hispanics (26.5%) than non-Hispanic Whites (22.5%), and this disparity is widening over time. Cognitive behavioral therapy for insomnia is a robustly effective psychological intervention for treatment of insomnia with sustained benefits, and is recommended over medications as the first-line treatment for chronic insomnia. Unfortunately, few receive this standard of care. Hispanics, and particularly those with limited English Proficiency, are even less likely than non-Hispanic Whites to have access to high quality evidence-based behavioral health care such as CBT-I, primarily because of the lack of available qualified bilingual behavioral providers trained to deliver CBT-I in Spanish and costs. Given the increasing prevalence of insomnia among Hispanics, and the linguistic realities of today's behavioral healthcare work force, the demand for bilingual behavioral health providers equipped to deliver CBT-I in Spanish significantly outweighs the supply. Advances in health information technology such as self-guided ehealth treatments represent an innovative and scalable means to address the supply and demand imbalance that perpetuate mental health care disparities, however its implementation in underserved communities remains elusive. In fact, CBT-I delivered via an online web-based platform is as effective as CBT-I delivered in-person, but extant ehealth programs of CBT-I have not been adapted for use among underserved patient populations. Further, data on the barriers and facilitators of implementation of these ehealth behavioral treatments in underserved racial/ethnic minority populations were rarely collected or used to support its integration in primary care. The proposed study will use a hybrid trial type 1 effectiveness-implementation study design and a mixed methods approach that leverages recent technological advances in ehealth platforms to (1) enroll 200 Spanish-speaking Hispanic primary care patients with chronic insomnia into an RCT that compares the effectiveness of a culturally adapted ehealth version of CBT-I with enhanced usual care on reduction of insomnia symptoms; (2) concurrently assess the organizational, patient, and provider barriers to implementation, and (3), determine the cost-effectiveness of the intervention. By leveraging recent advances in e-health and capitalizing on the increasing rates of Internet use among Hispanic US adults, this study has the potential to expand access to evidence-based alternatives to pharmacotherapy for the management of chronic insomnia, and to narrow existing racial/ethnic disparities in access to high quality behavioral health care for primary care patients.

超过3000万美国成年人和近20％的初级保健患者患有慢性失眠。慢性的 失眠与发病率，死亡率和高经济成本有关，因此代表 主要的公共卫生问题。重要的是，在西班牙裔中失眠的患病率明显更高 （26.5％）比非西班牙裔白人（22.5％），随着时间的流逝，这种差异正在扩大。认知行为 治疗失眠是一种可靠的心理干预，用于治疗失眠症 优势，建议将药物作为慢性失眠的一线治疗方法。很遗憾， 很少有人会收到此标准的护理。西班牙裔，尤其是英语能力有限的西班牙裔，甚至 与非西班牙裔白人相比，获得高质量的基于证据的行为保健的可能性较小 例如CBT-I，主要是因为缺乏可用的双语行为提供者 以西班牙语和成本交付CBT-I。鉴于西班牙裔人群中失眠的发生率越来越大， 当今行为医疗保健劳动力的语言现实，对双语行为健康的需求 配备了西班牙CBT-I的提供商大大超过了供应量。健康的进步 信息技术（例如自我引导的eHealth治疗）代表了一种创新且可扩展的手段 解决供求不平衡，使心理保健差异永存，但是 在服务不足的社区中实施仍然难以捉摸。实际上，CBT-I通过基于网络的在线网络交付 平台与CBT-I亲自交付一样有效，但现有的CBT-I的EHealth计划尚未 适用于服务不足的患者人群。此外，有关障碍和促进者的数据 在服务不足的种族/族裔少数民族中实施这些eHealth行为治疗是 很少收集或用于支持其在初级保健中的整合。拟议的研究将使用混合试验 1型有效性实施研究设计和一种利用最新的混合方法方法 eHealth平台的技术进步（1）注册200个讲西班牙语的西班牙裔初级保健患者 慢性失眠对RCT进行了比较，该RCT比较了文化适应的eHealth版本的有效性 CBT-I对减轻失眠症状的平常护理得到了增强； （2）同时评估 组织，病人和提供者实施障碍，（3）确定成本效益 干预。通过利用最近的电子卫生进展并利用互联网的增长率 在西班牙裔美国成年人中，这项研究有可能扩大获得基于证据的替代方案 治疗慢性失眠的药物治疗，并缩小现有的种族/种族差异 获得初级保健患者的高质量行为保健。