Reed Alexandra C, Rogers Daniel G, Berlin Gregory S, Burrone Laura, Dante Greg, DeViva Jason, McCarthy Elissa, Niculete Maria E, Santoro Gia, Hermes Eric D A
VA Connecticut Healthcare System, West Haven, CT, USA.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Behav Sleep Med. 2024 Nov-Dec;22(6):883-893. doi: 10.1080/15402002.2024.2385822. Epub 2024 Aug 14.
Cognitive Behavioral Therapy for Insomnia (CBTi) is a first-line treatment for a prevalent and impairing disorder. Digital CBTi programs increase access to internet-based self-directed care. However, the clinical effect of offering different forms of CBTi in a healthcare setting is not clearly understood. This study examines treatment engagement and clinical outcomes for individuals referred to either digital or provider-led CBTi.
Over two years, providers at a Veterans Health Administration (VHA) facility referred patients to digital CBTi with telephone coaching support or traditional provider-led CBTi. Characteristics of those referred, proportions engaging in and completing treatment, as well as insomnia severity were compared among those referred to each format.
Providers referred 139 individuals to digital CBTi, 340 to provider-led CBTi, and 14 to both formats. Individuals referred to digital CBTi were older with less severe insomnia. Despite lower levels of program engagement and completion in the digital CBTi cohort, measures of insomnia symptom change were similar between the groups.
This is the first study to evaluate both digital and provider-led evidence-based treatments for insomnia disorder simultaneously deployed in a healthcare setting. While engagement in digital CBTi lagged that for provider-led CBTi, offering both formats may expand access to different groups, while fostering similar outcomes.
失眠认知行为疗法（CBTi）是一种针对常见且有损健康的疾病的一线治疗方法。数字化CBTi项目增加了基于互联网的自我指导护理的可及性。然而，在医疗环境中提供不同形式的CBTi的临床效果尚不清楚。本研究考察了被转介接受数字化或由医疗服务提供者主导的CBTi治疗的个体的治疗参与度和临床结果。
在两年多的时间里，一家退伍军人健康管理局（VHA）机构的医疗服务提供者将患者转介至接受电话辅导支持的数字化CBTi或传统的由医疗服务提供者主导的CBTi。对每种形式转介患者的特征、参与和完成治疗的比例以及失眠严重程度进行了比较。
医疗服务提供者将139名个体转介至数字化CBTi，340名转介至由医疗服务提供者主导的CBTi，14名转介至两种形式。被转介接受数字化CBTi的个体年龄较大，失眠程度较轻。尽管数字化CBTi队列中的项目参与度和完成率较低，但两组之间失眠症状变化的测量结果相似。
这是第一项同时评估在医疗环境中同时部署的数字化和由医疗服务提供者主导的失眠症循证治疗方法的研究。虽然数字化CBTi的参与度落后于由医疗服务提供者主导的CBTi，但提供这两种形式可能会扩大不同群体的可及性，同时产生相似的结果。
