Bramoweth Adam D, Hough Caroline E, O'Brien Erin M, Klingaman Elizabeth A, Deininger Cara J, Ulmer Christi S, Boudreaux-Kelly Monique Y, McCoy Jennifer L, Youk Ada O
Department of Veterans Affairs Pittsburgh Healthcare System.
Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh.
Psychol Serv. 2025 Jan 2. doi: 10.1037/ser0000924.
Chronic insomnia is one of the most common health problems among veterans and can significantly impact health, function, and quality of life. Brief behavioral treatment for insomnia (BBTI), an adaptation of cognitive behavioral therapy for insomnia (CBT-I), was developed to help increase access to care outside of specialty settings. However, training providers alone is rarely sufficient, and implementation strategies are needed for successful uptake, adoption, and sustainable delivery of care. The current analysis compares the impact of providing BBTI training alone (BBTI) versus training plus implementation strategies (BBTI + IS) on veteran engagement in BBTI (i.e., reach) in Primary Care Mental Health Integration clinics. Providers from four Veterans Affairs (VA) medical centers completed BBTI training and then were given access to and support for implementation strategies. Core strategies implemented across all sites included developing an implementation blueprint, organizing implementation and educational meetings, developing and distributing educational materials, developing tools for quality monitoring, and facilitation. Veteran engagement in BBTI, CBT-I, insomnia diagnoses, and prescription sleep medication was measured using retrospective data from the VA Corporate Data Warehouse. Analyses were conducted using generalized linear models. Overall, sites significantly increased veteran engagement in BBTI (reach) from training alone and achieved further engagement with implementation strategies. At the site level, there was variability by phase, with three sites increasing BBTI only with training and one site increasing BBTI with training plus implementation support. These results are promising-increasing access to evidence-based behavioral insomnia care can be accomplished via BBTI training and easily implementable strategies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
慢性失眠是退伍军人中最常见的健康问题之一，会对健康、功能和生活质量产生重大影响。失眠简短行为治疗（BBTI）是认知行为疗法治疗失眠（CBT-I）的一种改编形式，旨在帮助增加在专科环境之外获得护理的机会。然而，仅培训提供者很少足够，成功采用、接受和持续提供护理需要实施策略。当前的分析比较了仅提供BBTI培训（BBTI）与培训加实施策略（BBTI + IS）对初级保健心理健康整合诊所中退伍军人参与BBTI（即覆盖面）的影响。来自四个退伍军人事务（VA）医疗中心的提供者完成了BBTI培训，然后获得了实施策略的资源和支持。所有站点实施的核心策略包括制定实施蓝图、组织实施和教育会议、开发和分发教育材料、开发质量监测工具以及提供便利。使用来自VA企业数据仓库的回顾性数据测量退伍军人对BBTI、CBT-I、失眠诊断和处方睡眠药物的参与情况。使用广义线性模型进行分析。总体而言，各站点通过仅培训显著提高了退伍军人对BBTI的参与度（覆盖面），并通过实施策略实现了进一步的参与。在站点层面，各阶段存在差异，三个站点仅通过培训增加了BBTI，一个站点通过培训加实施支持增加了BBTI。这些结果很有前景——通过BBTI培训和易于实施的策略可以增加获得循证行为性失眠护理的机会。（PsycInfo数据库记录（c）2025美国心理学会，保留所有权利）
