Insomnia is a common and complex problem among older adults and is associated with significant morbidity and mortality. Unfortunately, insomnia is often unrecognized and untreated in primary care settings, and offered treatment may be limited to medications alone rather than considering the full range of effective treatments, such as behavioral interventions, that are supported by strong evidence. Clinical practice guidelines for the treatment of insomnia are also available, including recent VHA guidelines for the treatment of insomnia among veterans in primary care. However, available evidence (both within and outside the VHA) suggests that gaps exist between best practices and current insomnia care in primary care settings. Our research program has focused on developing and testing interventions for treating sleep problems in older people. In the current study, we now propose to expand this work to translate evidence-based treatments and guidelines for insomnia into VHA primary care. We used the VHA HSR&D Quality Enhancement Research Initiative (QuERI) model as the framework for this work as a guide for translating research into practice and optimizing best practices throughout VHA. This proposal will focus on QuERI step 3, which involves defining existing practice patterns and outcomes across VHA and current variation from best practices. The primary aim of this proposal is to develop and pilot-test a survey instrument that measures practice patterns and identifies variation in VHA primary care providers' practices related to detection, assessment and treatment of insomnia in older veterans. For survey development and testing we will use a mixed methods approach that will include: 1) key respondent interviews with primary care providers (n=10) within VHA Greater Los Angeles Healthcare System; 2) focus group interviews with older veterans reporting symptoms of insomnia (n=40); 3) a technical advisory panel to help guide draft survey development based on key respondent interviews and patient focus groups, 4) pre-test of the draft survey in a small sample of primary care providers (n=10), and 5) pilot-test of the final survey in primary care providers (n=100) within VISN 22 to prepare for use of the survey in a larger future national sample of VHA providers. The immediate study objectives include : 1) Identify potential provider, patient and organizational factors that affect current practice patterns and implementation of best practices for the assessment and treatment of insomnia in older veterans, and 2) Develop and pilot-test a survey that measures practice patterns and identifies variation in primary care providers' insomnia care practices. The long-term objective of this research is to identify determinants of variation from evidence-based practices for insomnia care in older adults in a national sample of VHA primary care providers. This pre-implementation research will help guide future development of effective implementation strategies for evidence-based insomnia care within VHA primary care.
The veteran population is aging even more rapidly than the general population. Sleep disturbance is common among older veterans, may adversely affect their health and quality of life, and evidence suggests that it may be unrecognized and untreated in VHA. This study will develop an important tool to identify core issues in implementing evidence-based practices for insomnia.
| Fung, Constance H; Martin, Jennifer L; Josephson, Karen et al. (2018) Cognitive Expectancies for Hypnotic Use among Older Adult Veterans with Chronic Insomnia. Clin Gerontol 41:130-135 |
