Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment.
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2017-08
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Abstract
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Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that: sleep hygiene and pharmacotherapy are the primary treatments offered; PCPs tend to focus on perceived causes of insomnia rather than the insomnia itself; and neither patients nor providers are satisfied with insomnia treatment options. Although insomnia complaints are typically first reported to primary care providers, little research has focused on perspectives regarding insomnia treatment among PCPs working in the largest integrated health care system in the United States-the Veterans Affairs (VA) health care system. This study was conducted to examine VA PCP perceptions of the availability of insomnia treatments, identify specific strategies offered by PCPs, and examine perceptions regarding the importance of treating insomnia and the role of comorbid conditions.Methods
A survey was conducted within the VA health care system. Primary care providers completed surveys electronically.Results
A high percentage of veterans (modal response = 20% to 39%) seen in VA primary care settings report an insomnia complaint to their provider. Almost half of respondents do not consistently document insomnia in the medical record (46% endorsed "sometimes," "rarely," or "never"). PCPs routinely advise sleep hygiene recommendations for insomnia (ie, avoid stimulants before bedtime [84.3%], and keep the bedroom environment quiet and dark and comfortable [68.6%]) and many are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%).Conclusions
Findings point to the need for systems-level changes within health care systems, including the adoption of evidence-based clinical practice standards for insomnia and PCP education about the processes that maintain insomnia.Commentary
A commentary on this article appears in this issue on page 937.Type
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Ulmer, Christi S, Hayden B Bosworth, Jean C Beckham, Anne Germain, Amy S Jeffreys, David Edelman, Stephanie Macy, Angela Kirby, et al. (2017). Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 13(8). pp. 991–999. 10.5664/jcsm.6702 Retrieved from https://hdl.handle.net/10161/29905.
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Scholars@Duke
Christi S Ulmer
I am an Associate Professor at Duke University School of Medicine and clinical research psychologist at the Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT). My research is focused on increasing our understanding of the health correlates of sleep disorders, increasing patient access to behavioral sleep medicine, and developing and disseminating behaviorally-based treatments for sleep disorders. I am a Behavioral Sleep Medicine Diplomate who has been treating patients with sleep disturbances for the past 17 years. I serve as faculty on the Durham VA Health Psychology fellowship training program; the first accredited BSM training program in the VA healthcare system. I served as a VA Co-Chair for the development of VA/DOD Clinical Practice Guidelines for insomnia and sleep apnea, and served as a consultant on the VA Dissemination of training in Cognitive Behavioral Therapy for Insomnia for more than 8 years. I am committed to expanding patient access to and provider knowledge of effective behavioral sleep medicine interventions, and increasing the recognition of sleep’s role in patient health.
Jean Crowell Beckham
Interest in assessment and treatment of trauma, particularly as occurs for both women and men during military service; focus in treatment outcome of differential and collective contribution for psychopharmacological and behavioral interventions in PTSD populations; long term physical health effects of chronic posttraumatic stress disorder.
David Edward Edelman
My general interests are in the improve quality of care for chronic illness, using diabetes as a model. While I have performed research on screening for, diagnosis of, and clinical severity of unrecognized diabetes in patient care settings, my current line of work is in using health systems interventions to prevent cardiovascular disease, and to improve outcomes from comorbid diabetes and hypertension.
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