Exploring climate and context to inform implementation of a brief sleep health program for older primary care patients

点击翻译按钮获取中文摘要

ABSTRACT. Healthy-sleep wake patterns are critical to older adults’ cognitive health, functional capacity, mood, and overall quality-of-life. Up to two-thirds of older adults complain of insomnia symptoms, including difficulty falling or staying asleep, or poor nighttime sleep that results in daytime dysfunction. Despite the high prevalence of insomnia symptoms, as few as 25% of older adults have discussed sleep with a doctor. Insomnia can be safely and effectively treated with evidence-based behavioral treatments, including Cognitive Behavioral Therapy for Insomnia (CBTI). However, access to CBTI remains limited and few programs have been designed to meet the needs of older adults. Identifying existing care pathways, including primary care services, may help improve access to CBTI. Our team has previously developed and tested an effective behavioral sleep intervention designed to accommodate older adults’ cognitive and functional needs. Rooted in principles of CBTI, our four-session intervention was associated with objective improvements in nighttime sleep and subjective decreases in daytime dysfunction. The proposed research extends our team’s prior work and is the first step towards scale out of this effective geriatric insomnia intervention from VA to non-VA medical settings. This proposal is guided by the Exploration, Preparation, Implementation, and Sustainability (EPIS) Framework to explore the implementation climate and culture of local primary care clinics in regards to implementation of a brief insomnia intervention. This two-phased study includes an explanatory sequential mixed methods study followed by a series of co-design sessions to understand the implementation climate and context of local primary care settings, and to refine intervention procedures and implementation strategies. The study aims are as follows: Aim 1. Examine implementation climate and context related to integration of an evidence-based insomnia intervention for older adults seeking care in primary care clinics. Aim 1a. Identify current clinical practices related to insomnia in older adults, including estimated frequency of insomnia complaints, current assessment procedures, and available treatments. Aim 1b. In collaboration with patient and provider stakeholders, explore implementation barriers and facilitators. Aim 2. Engage key stakeholders (patients and providers) in a collaborative, co-design process to refine intervention procedures and implementation strategies. Quantitative surveys collected from patients and providers in Aim 1a will identify insomnia knowledge, beliefs, and attitudes as well past experiences with primary care-based insomnia screening and treatment. Survey findings will inform semi-structured interviews in Aim 1b. Co-design sessions with each patients and providers will determine how to integrate the intervention into local practices (e.g., training providers, screening procedures, and mode of intervention delivery). Findings generated by these aims will provide preliminary data to inform a R01 hybrid effectiveness implementation trial to examine the effectiveness of implementation strategies to integrate a geriatric insomnia intervention into primary care.