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Войти в исследования Journal of general internal medicine · 2026
Delivery of Behavioral Insomnia Care in VA Primary Care Mental Health Integration Clinics: Sustainment Outcomes of a Hybrid Type 3 Trial.
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Bramoweth Adam D, Ulmer Christi S, Klingaman Elizabeth A, O'Brien Erin M, Deininger Cara J, Boudreaux-Kelly Monique Y, Youk Ada O
Аннотация
BACKGROUND: Insomnia is a common disorder associated with significant negative health and functional consequences. Behavioral interventions, such as cognitive behavioral therapy for insomnia (CBT-I), are recommended and supported by training efforts, but access to care remains challenging for many.
OBJECTIVE: Evaluate change in the delivery of a brief behavioral treatment for insomnia (BBTI) following the withdrawal of implementation strategy support in Department of Veterans Affairs (VA) Primary Care Mental Health Integration (PCMHI) clinics.
DESIGN: A pre-post analysis of the withdrawal of implementation strategy support during the sustainment phase of a stepped wedge hybrid type 3 trial.
PARTICIPANTS: Veterans in Primary Care and PCMHI clinics at four VA Medical Centers.
INTERVENTIONS: Implementation, and withdrawal, of strategies and support to improve BBTI delivery in VA PCMHI clinics.
MAIN MEASURES: Delivery of BBTI, CBT-I, and total behavioral insomnia care in PCMHI clinics and prescriptions for sleep medications in Primary Care clinics.
KEY RESULTS: Across all four study sites, from phase 3 (implementation) to phase 4 (sustainment), delivery of BBTI in PCMHI increased 12.5% among Veterans with insomnia (20.2-32.7%, OR 1.9, p < 0.001) when implementation strategy support was withdrawn. Total behavioral insomnia care (BBTI + CBT-I) also increased (25.5-37.9%, OR 1.8, p < 0.001), although CBT-I delivery was stable during this time period (p = 0.8). Prescription sleep medications in Primary Care also reduced by 0.8% (n = 2158; OR 0.9, p < 0.001).
CONCLUSIONS: Across four VAMCs, BBTI training plus implementation strategy support increased the delivery of BBTI, and total behavioral insomnia care (BBTI + CBT-I), including the sustainment phase when implementation support was withdrawn. Increased access to behavioral insomnia care, notably through BBTI implementation, was also associated with decreased prescriptions of sleep medications. BBTI training and implementation support in PCMHI clinics help increase access to behavioral insomnia care and support the VA/DOD Clinical Practice Guidelines for insomnia disorder.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT04350866 (registered 04/14/2020).
OBJECTIVE: Evaluate change in the delivery of a brief behavioral treatment for insomnia (BBTI) following the withdrawal of implementation strategy support in Department of Veterans Affairs (VA) Primary Care Mental Health Integration (PCMHI) clinics.
DESIGN: A pre-post analysis of the withdrawal of implementation strategy support during the sustainment phase of a stepped wedge hybrid type 3 trial.
PARTICIPANTS: Veterans in Primary Care and PCMHI clinics at four VA Medical Centers.
INTERVENTIONS: Implementation, and withdrawal, of strategies and support to improve BBTI delivery in VA PCMHI clinics.
MAIN MEASURES: Delivery of BBTI, CBT-I, and total behavioral insomnia care in PCMHI clinics and prescriptions for sleep medications in Primary Care clinics.
KEY RESULTS: Across all four study sites, from phase 3 (implementation) to phase 4 (sustainment), delivery of BBTI in PCMHI increased 12.5% among Veterans with insomnia (20.2-32.7%, OR 1.9, p < 0.001) when implementation strategy support was withdrawn. Total behavioral insomnia care (BBTI + CBT-I) also increased (25.5-37.9%, OR 1.8, p < 0.001), although CBT-I delivery was stable during this time period (p = 0.8). Prescription sleep medications in Primary Care also reduced by 0.8% (n = 2158; OR 0.9, p < 0.001).
CONCLUSIONS: Across four VAMCs, BBTI training plus implementation strategy support increased the delivery of BBTI, and total behavioral insomnia care (BBTI + CBT-I), including the sustainment phase when implementation support was withdrawn. Increased access to behavioral insomnia care, notably through BBTI implementation, was also associated with decreased prescriptions of sleep medications. BBTI training and implementation support in PCMHI clinics help increase access to behavioral insomnia care and support the VA/DOD Clinical Practice Guidelines for insomnia disorder.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT04350866 (registered 04/14/2020).