Durham VA Health Services Research and Development, Durham, North Carolina.
Duke University Department of Psychiatry and Behavioral Sciences, Durham, North Carolina.
J Clin Sleep Med. 2017 Aug 15;13(8):991-999. doi: 10.5664/jcsm.6702.
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.
A survey was conducted within the VA health care system. Primary care providers completed surveys electronically.
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%).
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.
A commentary on this article appears in this issue on page 937.
失眠在美国成年人中是一个普遍存在的问题，退伍军人的失眠率甚至高于普通人群。先前研究调查了初级保健提供者（PCP）对失眠治疗的看法，发现：睡眠卫生和药物治疗是主要的治疗方法；PCP 倾向于关注失眠的潜在原因，而不是失眠本身；患者和提供者都对失眠治疗选择不满意。尽管失眠的抱怨通常首先向初级保健提供者报告，但很少有研究关注在美国最大的综合性医疗保健系统——退伍军人事务部（VA）医疗保健系统中工作的 PCP 对失眠治疗的看法。本研究旨在调查 VA PCP 对失眠治疗方法的可及性的看法，确定 PCP 提供的具体策略，并研究治疗失眠的重要性和共病状况的作用。
在 VA 医疗保健系统内进行了一项调查。初级保健提供者通过电子方式完成调查。
在 VA 初级保健环境中就诊的退伍军人中，有很大比例（模态反应=20%至 39%）向他们的提供者报告失眠。近一半的受访者并未在医疗记录中持续记录失眠（46%表示“有时”、“很少”或“从不”）。PCP 通常建议失眠的睡眠卫生建议（即睡前避免兴奋剂[84.3%]，保持卧室环境安静、黑暗和舒适[68.6%]），许多人不确定他们的机构是否提供失眠认知行为疗法（43.1%）。
研究结果表明，医疗保健系统需要进行系统层面的改变，包括采用失眠的循证临床实践标准，以及对 PCP 进行有关维持失眠的过程的教育。
本篇文章的评论见本期第 937 页。
