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

探索气候和背景，为老年初级保健患者实施简短的睡眠健康计划提供信息

• 批准号: 10705115
• 负责人: Jane M Hughes
• 金额: $ 23.25万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10705115
• 关键词: Acceleration; Activities of Daily Living; Adherence; Adoption; Attitude; Awareness; Behavior Therapy; Behavioral; Belief; Caring; Characteristics; Chronic Disease; Climate; Clinic; Clinical; Cognitive; Cognitive Therapy; Collaborations; Complex; Data; Data Sources; Disease Management; Early identification; Education; Elderly; Evidence based practice; Evidence based treatment; Exploration, Preparation, Implementation, and Sustainment; Feeling; Frequencies; Functional disorder; Glean; Goals; Health; Health Promotion; Health system; Healthcare Systems; High Prevalence; Impairment; Improve Access; Intervention; Interview; Knowledge; Left; Manuals; Medical; Medicine; Methods; Moods; Nurses; Nursing Homes; Pathway interactions; Patient Preferences; Patient Self-Report; Patients; Pattern; Persons; Phase; Physician Assistants; Physicians; Primary Care; Procedures; Process; Provider; Quality of life; Readiness; Regimen; Rehabilitation therapy; Reporting; Research; Screening procedure; Series; Services; Sleep; Sleeplessness; Social Workers; Structure; Surveys; Symptoms; Testing; Training; Work; care seeking; clinical practice; design; effective therapy; effectiveness evaluation; effectiveness/implementation trial; evidence base; experience; falls; functional decline; implementation barriers; implementation determinants; implementation facilitators; implementation framework; implementation strategy; improved; insight; intervention delivery; intervention participants; intervention refinement; member; preference; premature; primary care clinic; primary care patient; primary care services; primary care setting; programs; randomized trial; recruit; routine care; screening; secondary outcome; sleep behavior; sleep health; sustainability framework; therapy design; treatment program; user centered design

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.

摘要。健康的睡眠唤醒模式对老年人的认知健康，功能能力， 情绪和整体生活质量。多达三分之二的老年人抱怨失眠症状，包括 入睡或保持睡眠困难，或夜间睡眠不佳导致白天功能障碍。尽管高 尽管失眠症状普遍存在，但只有25%的老年人与医生讨论过睡眠问题。 通过循证行为治疗，包括认知行为治疗，可以安全有效地治疗抑郁症。 行为治疗（CBTI）。然而，获得CBTI的机会仍然有限， 旨在满足老年人的需求。确定现有的护理途径，包括初级保健 服务，可能有助于改善获得CBTI的机会。我们的团队以前开发并测试了一种有效的 旨在满足老年人认知和功能需求的行为睡眠干预。植根于 根据CBTI的原则，我们的四次干预与夜间睡眠的客观改善有关 和日间功能障碍的主观减少。拟议的研究扩展了我们团队先前的工作， 将这种有效的老年失眠干预措施从VA扩展到非VA医疗的第一步 设置.本提案以探索、准备、实施和可持续性（EPIS）为指导 探讨本地基层医疗诊所在以下方面的推行气候和文化的框架 进行简短的失眠干预。这两个阶段的研究包括一个解释性的顺序 混合方法研究，然后是一系列共同设计会议，以了解实施环境， 在这方面，我们的工作重点是在当地初级保健环境的背景下，并完善干预程序和实施战略。的 研究目的如下：目的1。审查与纳入一项战略有关的执行气候和背景， 对在初级保健诊所寻求护理的老年人进行循证失眠干预。目标1a。识别 与老年人失眠相关的当前临床实践，包括估计的失眠频率 投诉、当前评估程序和可用治疗。目标1b。与患者合作， 提供商利益相关者，探索实施障碍和促进因素。目标二。与关键利益攸关方接触 （患者和提供者）在协作、共同设计过程中完善干预程序， 执行战略。从目标1a中的患者和提供者收集的定量调查将确定 失眠知识、信念和态度以及过去基于初级保健的失眠经验 筛查和治疗。调查结果将为目标1b中的半结构化访谈提供信息。共同设计会议 每个患者和提供者将确定如何将干预整合到当地实践中（例如， 培训提供者、筛选程序和干预提供模式）。这些目标产生的结果 将提供初步数据，为R01混合动力车有效性实施试验提供信息， 将老年失眠症干预纳入初级保健的实施策略的有效性。