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

基本信息

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
项目类别：
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

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

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项目摘要

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.

抽象的。健康的睡眠唤醒模式对于老年人的认知健康，功能能力至关重要，心情和整体生活质量。多达三分之二的老年人抱怨失眠症状，包括跌倒或入睡困难，或夜间睡眠不佳，导致白天功能障碍。尽管很高失眠症状的患病率只有25％的老年人与医生讨论睡眠。失眠可以通过循证行为治疗（包括认知）安全有效地治疗失眠的行为疗法（CBTI）。但是，访问CBTI仍然有限，很少有程序旨在满足老年人的需求。确定包括初级保健在内的现有护理途径服务，可能有助于改善对CBTI的访问。我们的团队以前已经开发并测试了有效的行为睡眠干预旨在适应老年人的认知和功能需求。扎根 CBTI原则，我们的四项干预措施与夜间睡眠的客观改善有关白天功能障碍的主观下降。拟议的研究扩展了我们团队的先前工作，是从VA到非VA医疗的这一有效的老年失眠干预措施迈出的第一步设置。该提案以探索，准备，实施和可持续性为指导（EPIS）探索当地初级保健诊所的实施气候和文化的框架实施短暂的失眠干预。这项两步研究包括爆炸性顺序混合方法研究，然后进行一系列共同设计会议，以了解实施氛围和本地初级保健环境的背景，并完善干预程序和实施策略。研究目的如下：目标1。检查实施气候和与整合基于证据的失眠干预措施在初级保健诊所寻求护理的老年人。目标1a。确认当前与老年人失眠有关的临床实践，包括估计的失眠频率投诉，当前的评估程序和可用治疗方法。目标1B。与患者合作提供者利益相关者，探索实施障碍和促进者。目标2。吸引主要利益相关者（患者和提供者）在协作，共同设计的过程中，以完善干预程序和实施策略。 AIM 1A中的患者和提供者收集的定量调查将确定失眠知识，相信并参加了基于初级保健的失眠症的经验筛查和治疗。调查结果将为AIM 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决定如何将干预措施整合到地方实践中（例如，培训提供者，筛查程序和干预交付方式）。这些目标产生的发现将提供初步数据，以告知R01混合有效性实施试验，以检查实施策略的有效性将老年失眠干预融合到初级保健中。