A Stepped Care Model for Treating Sleep Disturbance in OEF/OIF Veterans

治疗 OEF/OIF 退伍军人睡眠障碍的阶梯式护理模式

• 批准号: 8844251
• 负责人: Christi S Ulmer
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-01-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8844251
• 关键词: Address; Applications Grants; Attention; Award; Behavior Therapy; Behavioral; Blood Pressure; Caring; Chronic; Chronic Disease; Clinic; Clinical Services; Cognitive Therapy; Conflict (Psychology); Depression and Suicide; Development; Effectiveness; Elements; Feasibility Studies; Focus Groups; Freedom; Future; Goals; Health; Health Care Costs; Health Personnel; Healthcare; Hypertension; Individual; Intervention; Knowledge; Medical; Medicine; Mental Depression; Mental Health; Metabolic syndrome; Methods; Modality; Modeling; Names; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Patients; Perception; Pilot Projects; Plague; Population; Post-Traumatic Stress Disorders; Prevalence; Primary Insomnia; Process; Provider; Research; Research Project Grants; Research Training; Resources; Risk; Role; Self Management; Services; Sleep; Sleep disturbances; Sleeplessness; Societies; Staging; Substance abuse problem; Surveys; Symptoms; Testing; Training; Training Activity; Traumatic Brain Injury; Treatment Effectiveness; Veterans; Writing; base; cost effective; design; group intervention; improved; innovation; interest; medical specialties; mortality; obesity risk; operation; physical conditioning; preference

DESCRIPTION (provided by applicant): Sleep disturbance is one of the most common complaints among recently deployed Veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (hereinafter RD Veterans). Research suggests that up to sixty percent return from deployment with insomnia; further complicating the difficult process of re-integration into civilian society. Sleep disturbance is associated with a range of health conditions, including obesity, metabolic syndrome, Type 2 diabetes mellitus, and all-cause mortality. Insomnia is also associated with a range of mental health conditions, including those which are prevalent in RD veterans; such as PTSD and depression. Cognitive-Behavioral Therapy for Insomnia has demonstrated efficacy for improving sleep in those with both primary insomnia, and insomnia that is comorbid with both medical and mental health conditions. Healthcare costs associated with insomnia, which are estimated to be in the billions of US dollars annually, are largely associated with the increased risk of various psychiatric and medical conditions. In spite of the prevalence of sleep disturbance in RD Veterans, VA behavioral resources for addressing insomnia are very limited. Efforts are underway to increase access to behavioral treatment of insomnia by training mental health providers to provide Cognitive-Behavioral Therapy for Insomnia (CBTI). However, when considering the combined needs of RD Veterans and those serving in earlier services eras, treatment resources will remain limited. Thus, innovative treatment approaches are imminently needed to address these concerns and impede the adverse health consequences of untreated sleep disturbance. A stepped model of care may be a cost-effective method for achieving these objectives. By first addressing the needs of those who are receptive and responsive to entry level self-management approaches, higher level, clinic-based resources can be reserved for those whose symptoms require the attention of an individual health care provider. The proposed research involves designing a stepped care model for insomnia treatment in RD Veterans that can be readily integrated with existing VA clinical services. The model involves an entry level self-management intervention, a secondary group intervention, and individual therapy as the tertiary level. Projects are proposed to accomplish three primary objectives: 1) Obtain patient and provider perspectives and preferences for insomnia treatment; 2) Evaluate the feasibility of implementing a stepped care model for insomnia treatment; and 3) Write, submit, and revise an IIR grant application to assess the effectiveness of a stepped care model for insomnia treatment in recently deployed Veterans. In preliminary projects, survey research will be used to examine VA provider perspectives nationwide, and focus groups will be used to explore emerging themes in greater depth. Patient focus groups will be used to obtain treatment preferences and perspectives on the proposed model of care. Preliminary project findings will be used to inform the design of a study evaluating the feasibility and acceptability of a stepped care model. Feasibility study findings will be used to prepare a Merit Review application to evaluate the effectiveness of the treatment model. With our increasing knowledge of the role of sleep disturbance in the development of mental health and chronic disease conditions, we have an opportunity with our younger Veteran population to impede the development of many conditions which have plagued our older Veterans. Although the VA is training mental health providers in CBTI, health care resources to address insomnia will continue to be limited. With limited clinical services readily available to address these concerns, self-management interventions could be an important element of treatment that may also hasten the reduction of long-term risks of insomnia. A stepped care approach which includes an entry level self-management intervention will maximize our limited VA sleep specialty resources.

描述（由申请人提供）： 睡眠障碍是最近部署的持久自由行动、伊拉克自由行动和新黎明行动退伍军人（以下简称RD退伍军人）最常见的主诉之一。研究表明，多达60%的人从部署返回时患有失眠症;这进一步使重新融入平民社会的困难过程变得复杂。睡眠 疾病与一系列健康状况相关，包括肥胖、代谢综合征、2型糖尿病和全因死亡率。抑郁症还与一系列心理健康状况有关，包括RD退伍军人中普遍存在的那些;如PTSD和抑郁症。失眠的认知行为疗法已证明对改善原发性失眠和与医学和心理健康状况并存的失眠患者的睡眠有效。与失眠相关的医疗费用估计每年达数十亿美元，这在很大程度上与各种精神和医疗状况的风险增加有关。 尽管研发部退伍军人中睡眠障碍的患病率很高，但用于解决失眠问题的VA行为资源非常有限。目前正在努力通过培训心理健康提供者提供失眠症认知行为治疗（CBTI）来增加失眠症的行为治疗。然而，当考虑到研发退伍军人和那些在早期服务时代服务的人的综合需求时，治疗资源仍然有限。因此，迫切需要创新的治疗方法来解决这些问题，并阻止未经治疗的睡眠障碍的不良健康后果。逐步护理模式可能是实现这些目标的具有成本效益的方法。通过首先解决那些接受和响应入门级自我管理方法的人的需求，可以为那些症状需要个别卫生保健提供者关注的人保留更高级别的基于诊所的资源。 拟议的研究涉及设计一种用于RD退伍军人失眠治疗的阶梯式护理模式，该模式可以很容易地与现有的VA临床服务整合。该模式包括一个入门级的自我管理干预，第二组干预，和个人治疗作为第三级。提出项目以实现三个主要目标：1）获得患者和供应商的观点和偏好失眠治疗; 2）评估实施失眠治疗阶梯式护理模式的可行性;和3）编写，提交和修改IIR拨款申请，以评估最近部署的退伍军人失眠治疗阶梯式护理模式的有效性。在初步项目中，调查研究将用于检查全国范围内的VA提供者的观点，焦点小组将用于更深入地探索新出现的主题。患者焦点小组将用于获得治疗偏好和对拟议的护理模式的看法。初步的项目结果将被用来通知一项研究的设计评估的可行性和可接受的阶梯式护理模式。可行性研究结果将用于准备Merit Review申请，以评估治疗模式的有效性。 随着我们对睡眠障碍在心理健康和慢性疾病发展中的作用的了解越来越多，我们有机会与年轻的退伍军人一起阻止困扰我们老年退伍军人的许多疾病的发展。虽然退伍军人事务部正在培训CBTI的心理健康提供者，但解决失眠问题的医疗资源将继续有限。由于有限的临床服务可随时解决这些问题，自我管理干预可能是治疗的一个重要因素，也可能加速降低失眠的长期风险。包括入门级自我管理干预的阶梯式护理方法将最大限度地利用我们有限的VA睡眠专业资源。