-
Views
-
Cite
Cite
Jack D. Edinger, Janet Grubber, Christi Ulmer, Jennifer Zervakis, Maren Olsen, A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial, Sleep, Volume 39, Issue 1, January 2016, Pages 237–247, https://doi.org/10.5665/sleep.5356
Close - Share Icon Share
Abstract
To test a collaborative care model for interfacing sleep specialists with primary care providers to enhance patients' sleep disorders management.
This study used a randomized, parallel group, clinical intervention trial design. A total of 137 adult (29 women) VA outpatients with sleep complaints were enrolled and randomly assigned to (1) an intervention (INT) consisting of a one-time consultation with a sleep specialist who provided diagnostic feedback and treatment recommendations to the patient and the patient's primary care provider; or (2) a control condition consisting of their usual primary care (UPC). Provider-focused outcomes included rates of adherence to recommended diagnostic procedures and sleep-focused interventions. Patient-focused outcomes included measures taken from sleep diaries and actigraphy; Pittsburgh Sleep Quality Index (PSQI) scores; and self-report measures of sleepiness, fatigue, mood, quality of life, and satisfaction with health care.
The proportions of provider-initiated sleep-focused interventions were significantly higher in the INT group than in the UPC group for polysomnography referrals (49% versus 6%; P <0.001) and mental health clinic referrals (19% versus 6%; P = 0.02). At the 10-mo follow up, INT recipients showed greater estimated mean reductions in diary total wake time (-17.0 min; 95% confidence interval [CI]: −30.9, −3.1; P = 0.02) and greater increases in sleep efficiency (+3.7%; 95% CI: 0.8, 6.5; P = 0.01) than did UPC participants. A greater proportion of the INT group showed ≥ 1 standard deviation decline on the PSQI from baseline to the 10-mo follow-up (41% versus 21%; P = 0.02). Moreover, 69% of the INT group had normal (≤ 10) Epworth Sleepiness Scale scores at the 10-mo follow-up, whereas only 50% of the UPC group fell below this clinical cutoff (P = 0.03).
A one-time sleep consultation significantly increased healthcare providers' attention to sleep problems and resulted in benefits to patients' sleep/wake symptoms.
This study is registered with clinicaltrials.gov with identifier # NCT00390572.
Determining the optimal interface between primary and specialty care remains a challenge. Specifically it is often difficult to determine what level of specialty care involvement is needed to assist primary care providers in their management of the various disorders their patients present. The current trial entailed a novel, initial attempt to examine this question in regard to the management of sleep disorders. Specifically this study tested the usefulness of a single sleep specialist consultation that resulted in the specialist's guidance and advice conveyed to both the patient and the patient's provider. The highly promising results confirmed the usefulness and efficacy of this sort of intervention for guiding providers' practice patterns so as to more effectively address their patients' sleep complaints.
Comments