Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Baystate Health, Springfield, Massachusetts.
J Clin Sleep Med. 2021 Aug 1;17(8):1675-1684. doi: 10.5664/jcsm.9280.
To determine if a population health approach to insomnia using internet-based cognitive behavioral therapy for insomnia (ICBT-I) affects dispensed medications and provider encounters compared with usual care.
A pragmatic hybrid study design was used to evaluate both the implementation strategy and the long-term effects of ICBT-I on health care utilization in an integrated health system. Adult members with insomnia (a diagnosis or insomnia medication dispensation) or at high risk of insomnia (a diagnosis of depression or anxiety) were randomized to receive information on either an ICBT-I program (intervention arm) or in-person classes on insomnia (usual-care arm). Outcomes included dispensed insomnia medications and provider encounters over 12 months. The effectiveness of our implementation of ICBT-I on the target population was determined by an intention-to-treat analysis and by regression models comparing those who engaged in ICBT-I with matched usual-care arm controls.
A total of 136,630 participants were randomized. Six hundred thirty-eight (0.96%) accessed the ICBT-I program while 431 (0.66%) attended 1 or more usual-care insomnia classes. Dispensed insomnia medications and provider encounters were no different in the ICBT-I arm vs the usual-care arm (intention-to-treat) or among those who engaged in ICBT-I vs matched usual-care arm controls.
Since ICBT-I program engagement was low, additional strategies to improve engagement should be explored. ICBT-I did not result in a reduction in several measures of health care utilization; nevertheless, it offers an alternative and accessible approach to managing population insomnia.
Registry: ClinicalTrials.gov; Name: Trial of Internet-Based Cognitive Behavioral Therapy for Insomnia in Patients Prescribed Insomnia Medications; URL: https://clinicaltrials.gov/ct2/show/NCT03313466; Identifier: NCT03313466.
Derose SF, Rozema E, Chen A, Shen E, Hwang D, Manthena P. A population health approach to insomnia using internet-based cognitive behavioral therapy for insomnia. . 2021;17(8):1675-1684.
确定采用基于互联网的认知行为疗法治疗失眠症（ICBT-I）的人群健康方法是否会影响配药和医疗服务提供者的就诊次数，与常规护理相比。
采用实用混合研究设计，评估 ICBT-I 的实施策略以及在综合卫生系统中对医疗保健利用的长期影响。有失眠症（诊断或失眠药物配药）或有失眠症高风险（抑郁或焦虑诊断）的成年成员被随机分配到接受有关 ICBT-I 计划（干预组）或有关失眠症的面授课程（常规护理组）的信息。12 个月期间的结果包括配给的失眠症药物和医疗服务提供者就诊次数。通过意向治疗分析和回归模型比较接受 ICBT-I 的人与匹配的常规护理组对照，确定我们对目标人群实施 ICBT-I 的效果。
共有 136630 名参与者被随机分配。有 638 人（0.96%）访问了 ICBT-I 计划，而有 431 人（0.66%）参加了 1 次或多次常规护理失眠课程。意向治疗中，ICBT-I 组与常规护理组之间的配给失眠症药物和医疗服务提供者就诊次数没有差异（意向治疗）或在接受 ICBT-I 的人与匹配的常规护理组对照之间。
由于 ICBT-I 计划的参与率较低，应探索提高参与率的其他策略。ICBT-I 并没有导致多项医疗保健利用指标的减少；然而，它为管理人群失眠症提供了一种替代和可及的方法。
注册处：ClinicalTrials.gov；名称：互联网为基础的认知行为疗法治疗失眠症患者处方失眠症药物的试验；网址：https://clinicaltrials.gov/ct2/show/NCT03313466；标识符：NCT03313466。
Derose SF、Rozema E、Chen A、Shen E、Hwang D、Manthena P. 采用基于互联网的认知行为疗法治疗失眠症的人群健康方法。. 2021;17(8):1675-1684。
