Christi S Ulmer1,2, Hayden B Bosworth1,3, Jean C Beckham2,4, Anne Germain5, Amy S Jeffreys1, David Edelman1,6, Stephanie Macy1, Angela Kirby4, Corrine I Voils7,8. 1. Durham VA Health Services Research and Development, Durham, North Carolina. 2. Duke University Department of Psychiatry and Behavioral Sciences, Durham, North Carolina. 3. Duke University School of Nursing, Durham, North Carolina. 4. Veterans Affairs VISN 6 Mental Illness Research, Education, and Clinical Center, Durham, North Carolina. 5. University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania. 6. Department of Medicine, Duke University Medical Center, Durham, North Carolina. 7. William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin. 8. Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
Abstract
STUDY OBJECTIVES: Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that: sleep hygiene and pharmacotherapy are the primary treatments offered; PCPs tend to focus on perceived causes of insomnia rather than the insomnia itself; and neither patients nor providers are satisfied with insomnia treatment options. Although insomnia complaints are typically first reported to primary care providers, little research has focused on perspectives regarding insomnia treatment among PCPs working in the largest integrated health care system in the United States-the Veterans Affairs (VA) health care system. This study was conducted to examine VA PCP perceptions of the availability of insomnia treatments, identify specific strategies offered by PCPs, and examine perceptions regarding the importance of treating insomnia and the role of comorbid conditions. METHODS: A survey was conducted within the VA health care system. Primary care providers completed surveys electronically. RESULTS: A high percentage of veterans (modal response = 20% to 39%) seen in VA primary care settings report an insomnia complaint to their provider. Almost half of respondents do not consistently document insomnia in the medical record (46% endorsed "sometimes," "rarely," or "never"). PCPs routinely advise sleep hygiene recommendations for insomnia (ie, avoid stimulants before bedtime [84.3%], and keep the bedroom environment quiet and dark and comfortable [68.6%]) and many are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%). CONCLUSIONS: Findings point to the need for systems-level changes within health care systems, including the adoption of evidence-based clinical practice standards for insomnia and PCP education about the processes that maintain insomnia. COMMENTARY: A commentary on this article appears in this issue on page 937.
STUDY OBJECTIVES:Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that: sleep hygiene and pharmacotherapy are the primary treatments offered; PCPs tend to focus on perceived causes of insomnia rather than the insomnia itself; and neither patients nor providers are satisfied with insomnia treatment options. Although insomnia complaints are typically first reported to primary care providers, little research has focused on perspectives regarding insomnia treatment among PCPs working in the largest integrated health care system in the United States-the Veterans Affairs (VA) health care system. This study was conducted to examine VA PCP perceptions of the availability of insomnia treatments, identify specific strategies offered by PCPs, and examine perceptions regarding the importance of treating insomnia and the role of comorbid conditions. METHODS: A survey was conducted within the VA health care system. Primary care providers completed surveys electronically. RESULTS: A high percentage of veterans (modal response = 20% to 39%) seen in VA primary care settings report an insomnia complaint to their provider. Almost half of respondents do not consistently document insomnia in the medical record (46% endorsed "sometimes," "rarely," or "never"). PCPs routinely advise sleep hygiene recommendations for insomnia (ie, avoid stimulants before bedtime [84.3%], and keep the bedroom environment quiet and dark and comfortable [68.6%]) and many are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%). CONCLUSIONS: Findings point to the need for systems-level changes within health care systems, including the adoption of evidence-based clinical practice standards for insomnia and PCP education about the processes that maintain insomnia. COMMENTARY: A commentary on this article appears in this issue on page 937.
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