دورية أكاديمية
Survey of Resources in Behavioral Sleep Medicine Across the Department of Defense, Defense Health Agency.
| العنوان: | Survey of Resources in Behavioral Sleep Medicine Across the Department of Defense, Defense Health Agency. |
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| المؤلفون: | Germain A; NOCTEM, LLC, Pittsburgh, PA 15213, USA., Wolfson M; NOCTEM, LLC, Pittsburgh, PA 15213, USA., Klenczar B; University of Nevada, Las Vegas, Nevada, School of Public Health, Las Vegas, NV 89119, USA., Brock MS; Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, USA., Hearn H; Carl R. Darnall Army Medical Center, Sleep Disorder Center, Fort Hood, TX 76544, USA., O'Reilly B; Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA., Blue Star J; Hanscom Air Force Base, Bedford, MA 01730, USA., Mysliwiec V; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. |
| المصدر: | Military medicine [Mil Med] 2024 May 18; Vol. 189 (5-6), pp. e1089-e1097. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 2984771R Publication Model: Print Cited Medium: Internet ISSN: 1930-613X (Electronic) Linking ISSN: 00264075 NLM ISO Abbreviation: Mil Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : Oxford : Oxford University Press Original Publication: Washington, D.C. : Association of Military Surgeons, United States, 1955- |
| مواضيع طبية MeSH: | Sleep Initiation and Maintenance Disorders*/therapy , Sleep Initiation and Maintenance Disorders*/psychology , United States Department of Defense*/organization & administration , United States Department of Defense*/statistics & numerical data, Humans ; United States ; Surveys and Questionnaires ; Behavioral Medicine/methods ; Behavioral Medicine/statistics & numerical data ; Behavioral Medicine/standards ; Military Personnel/statistics & numerical data ; Military Personnel/psychology ; Male ; Adult ; Cognitive Behavioral Therapy/methods ; Cognitive Behavioral Therapy/statistics & numerical data ; Cognitive Behavioral Therapy/standards ; Female |
| مستخلص: | Introduction: Insomnia affects approximately 40% of active duty service members and adversely affects health, readiness, and safety. The VA/DoD Clinical Practice Guideline for the management of insomnia recommends cognitive-behavioral treatment of insomnia (CBTI) or its abbreviated version (brief behavioral treatment of insomnia [BBTI]) as the first-line insomnia treatment. The goal of this study was to assess CBTI/BBTI resources at MTFs, perceived facilitators and barriers for CBTI/BBTI, and gaps in these treatments across the Defense Health Agency. Materials and Methods: Between July and October 2022, we conducted an electronic survey of CBTI/BBTI resources across Contiguous United States and the District of Columbia (CONUS) and Outside Continental United States (OCONUS) MTFs. The survey was distributed to 154 military sleep health care providers from 32 MTFs, and a link to the survey was posted on two online military sleep medicine discussion forums. Fifteen providers from 12 MTFs volunteered to complete a 30-minute qualitative interview to explore their perception of barriers and facilitators of CBTI/BBTI at their facility. Results: Fifty-two of 154 providers (33.8%) at 20 MTFs completed the survey. A majority of providers indicated that hypnotics remain the most common treatment for insomnia at their facility. Sixty-eight percent reported that CBTI/BBTI was available at their facility and estimated that less than 50% of the patients diagnosed with insomnia receive CBTI/BBTI. The main facilitators were dedicated, trained CBTI/BBTI providers and leadership support. Referrals to the off-post civilian network and self-help apps were not perceived as significant facilitators for augmenting insomnia care capabilities. The primary barriers to offering CBTI/BBTI were under-resourced clinics to meet the high volume of patients presenting with insomnia and scheduling and workflow limitations that impede repeated treatment appointments over the period prescribed by CBTI/BBTI protocols. Four primary themes emerged from qualitative interviews: (1) CBTI/BBTI groups can scale access to insomnia care, but patient engagement and clinical outcomes are perceived as inferior to individual treatment; (2) embedding trained providers in primary or behavioral health care could accelerate access, before escalation and referral to a sleep clinic; (3) few providers have the time to adhere to traditional CBTI protocols, and appointment scheduling often does not support weekly or bi-weekly treatment visits; and (4) the absence of quality and/or continuity of care measures dampens providers' enthusiasm for using external referral resources or self-help apps. Conclusions: Although there is a wide recognition that CBTI/BBTI is the first-line recommended insomnia treatment, the limited scalability of treatment protocols, clinical workflow limitations, and scarcity of trained CBTI/BBTI providers limit the implementation of the VA/DoD clinical guideline. Educating and engaging health care providers and leadership about CBTI, augmenting CBTI-dedicated resources, and adapting clinical workflows were identified as specific strategies needed to meet the current insomnia care needs of service members. Developing protocols for scaling the availability of CBTI expertise at diverse points of care, upstream from the sleep clinics, could accelerate access to care. Establishing standardized quality measures and processes across points of care, including for external providers and self-help apps, would enhance providers' confidence in the quality of insomnia care offered to service members. (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.) |
| معلومات مُعتمدة: | JW210372 Joint Warfighter Medical Research Program FY21 |
| تواريخ الأحداث: | Date Created: 20231021 Date Completed: 20240522 Latest Revision: 20240523 |
| رمز التحديث: | 20240523 |
| DOI: | 10.1093/milmed/usad409 |
| PMID: | 37864822 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1930-613X |
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| DOI: | 10.1093/milmed/usad409 |