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：健康的睡眠觉醒模式对于老年人的认知健康、功能能力、 多达三分之二的老年人抱怨失眠症状，包括失眠症状。 入睡或保持睡眠困难，或夜间睡眠不佳导致白天功能障碍。 失眠症状普遍存在，只有 25% 的老年人曾与医生讨论过睡眠问题。 失眠可以通过基于证据的行为治疗来安全有效地治疗，包括认知疗法 失眠行为疗法 (CBTI) 然而，获得 CBTI 的机会仍然有限，而且很少有项目能够实现。 旨在满足老年人的需求，确定现有的护理途径，包括初级护理。 服务，可能有助于改善 CBTI 的获取，我们的团队之前已经开发并测试了有效的方法。 行为睡眠干预旨在满足老年人的认知和功能需求。 根据 CBTI 的原则，我们的四次干预与夜间睡眠的客观改善相关 以及减少主观白天功能障碍。拟议的研究扩展了我们团队之前的工作。 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 该提案以探索、准备、实施和可持续性 (EPIS) 为指导。 探索当地初级保健诊所在以下方面的气候和文化的框架 实施简短的失眠干预措施这项分两阶段的研究包括一项解释性的顺序研究。 混合方法研究，随后进行一系列协同设计会议，以了解实施环境和 当地初级保健机构的背景，并完善干预程序和实施策略。 研究目标如下： 目标 1. 检查与整合相关的实施氛围和背景 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。 当前与老年人失眠相关的临床实践，包括估计的失眠频率 目标 1b. 与患者合作。 目标 2. 吸引关键利益相关者参与 （患者和提供者）在协作、共同设计的过程中完善干预程序和 目标 1a 中从患者和提供者那里收集的定量调查将确定实施策略。 失眠知识、信念和态度以及过去以初级保健为基础的失眠经历 调查结果将为目标 1b 中的半结构化访谈提供信息。 与每位患者和提供者一起确定如何将干预措施融入当地实践（例如， 这些目标产生的结果 将提供初步数据，为 R01 混合有效性实施试验提供信息，以检查 将老年失眠干预纳入初级保健的实施策略的有效性。