Psychiatry · General Practice · 2 h ago
Behavioral insomnia care increased in VA clinics after implementation support ended
A pre-post sustainment analysis across four VA medical centers found that delivery of brief behavioral treatment for insomnia (BBTI) increased after implementation support was withdrawn. Total behavioral insomnia care also rose, while sleep-medication prescriptions in primary care declined slightly.
- BBTI delivery rose from 20.2% to 32.7%.
- Total behavioral insomnia care increased during sustainment.
- CBT-I delivery remained stable.
- Primary-care sleep-medication prescriptions declined by 0.8%.
This pre-post analysis examined the sustainment phase of a stepped-wedge hybrid type 3 trial in Primary Care Mental Health Integration (PCMHI) clinics at four VA medical centers. The researchers assessed delivery of brief behavioral treatment for insomnia (BBTI), cognitive behavioral therapy for insomnia (CBT-I), total behavioral insomnia care, and sleep-medication prescriptions in primary care after implementation strategy support was withdrawn. The abstract does not report the total number of veterans assessed; prescription findings included 2,158 observations.
From the implementation phase to sustainment, BBTI delivery among veterans with insomnia increased from 20.2% to 32.7% (odds ratio [OR] 1.9; p<0.001). Total behavioral insomnia care, combining BBTI and CBT-I, increased from 25.5% to 37.9% (OR 1.8; p<0.001), while CBT-I delivery remained stable (p=0.8). Sleep-medication prescriptions in primary care decreased by 0.8% (OR 0.9; p<0.001).
The findings suggest that behavioral insomnia care delivery was sustained and increased after support was withdrawn in these VA clinics. The prescription decrease was small, and the study’s pre-post design does not establish that increased behavioral care caused the change. Results from four VA centers may not generalize to other settings.
In practice
For VA primary care mental health integration clinics, the findings support the feasibility of sustaining and increasing delivery of behavioral insomnia care, particularly BBTI, after implementation support ends. They do not establish that the intervention reduced sleep-medication prescribing: prescriptions declined only slightly, and the pre-post analysis cannot show causation. The results come from four VA medical centers, so applicability to other health systems is uncertain; they do not establish a need to change individual prescribing practice.
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Journal of General Internal Medicine: Delivery of Behavioral Insomnia Care in VA Primary Care Mental Health Integration Clinics: Sustainment Outcomes of a Hybrid Type 3 Trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.