Abstract
BackgroundSleep problems are common, affecting over a third of adults in the United Kingdom and leading to reduced productivity and impaired health-related quality of life. Many of those whose lives are affected seek medical help from primary care. Drug treatment is ineffective long term. Psychological methods for managing sleep problems, including cognitive behavioural therapy for insomnia (CBTi) have been shown to be effective and cost effective but have not been widely implemented or evaluated in a general practice setting where they are most likely to be needed and most appropriately delivered. This paper outlines the protocol for a pilot study designed to evaluate the effectiveness and cost-effectiveness of an educational intervention for general practitioners, primary care nurses and other members of the primary care team to deliver problem focused therapy to adult patients presenting with sleep problems due to lifestyle causes, pain or mild to moderate depression or anxiety.Methods and designThis will be a pilot cluster randomised controlled trial of a complex intervention. General practices will be randomised to an educational intervention for problem focused therapy which includes a consultation approach comprising careful assessment (using assessment of secondary causes, sleep diaries and severity) and use of modified CBTi for insomnia in the consultation compared with usual care (general advice on sleep hygiene and pharmacotherapy with hypnotic drugs). Clinicians randomised to the intervention will receive an educational intervention (2 × 2 hours) to implement a complex intervention of problem focused therapy. Clinicians randomised to the control group will receive reinforcement of usual care with sleep hygiene advice. Outcomes will be assessed via self-completion questionnaires and telephone interviews of patients and staff as well as clinical records for interventions and prescribing.DiscussionPrevious studies in adults have shown that psychological treatments for insomnia administered by specialist nurses to groups of patients can be effective within a primary care setting. This will be a pilot study to determine whether an educational intervention aimed at primary care teams to deliver problem focused therapy for insomnia can improve sleep management and outcomes for individual adult patients presenting to general practice. The study will also test procedures and collect information in preparation for a larger definitive cluster-randomised trial. The study is funded by The Health Foundation.Trial RegistrationClinicalTrials.gov ID ISRCTN55001433 –
Highlights
Sleep problems are common, affecting over a third of adults in the United Kingdom and leading to reduced productivity and impaired health-related quality of life
We have shown in modelling studies involving patients, practitioners and practices that despite patients trying various self-help remedies and sometimes expecting a prescription when presenting with sleep problems, they welcome a consultation approach which includes careful assessment and advice about non-pharmacological methods rather than a prescription. [14,15,16] Practitioners are generally positive towards finding new approaches that enhance their skills in non-pharmacological management methods
The definitive trial will investigate the effectiveness and cost-effectiveness of a brief practice-based educational intervention (2 × 2 hours) for practice teams (GPs, primary care nurses and practice managers) to provide problem focused therapy for insomnia in adults involving the use of sleep assessment tools and modified cognitive behavioural therapy for insomnia (CBTi) on sleep outcomes compared to usual care
Summary
Sleep problems are common, affecting over a third of adults in the United Kingdom and leading to reduced productivity and impaired health-related quality of life Many of those whose lives are affected seek medical help from primary care. Insomnia and sleep problems are common, affecting over a third of adults in the United Kingdom.[1,2] Many of those whose lives are affected seek medical help from primary care.[3] A review of cost effectiveness studies of diagnosis and treatment of insomnia highlighted that insomnia has a high economic cost on society, in terms of productivity loss and impaired healthrelated quality of life.[4]. A compelling case exists for both improving quality of care for these patients and doing so by encouraging changes in prescribing, there is less evidence about how to achieve these outcomes
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