A population health approach to insomnia using internet-based cognitive behavioral therapy for insomnia
Study objectives: 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 to usual care.
Methods: 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 to matched usual care arm controls.
Results: 136,630 subjects were randomized. 638 (0.96%) accessed the ICBT-I program while 431 (0.66%) attended one 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.
Conclusions: 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.
Clinical trial registration: Registry: ClinicalTrials.gov; Name: Trial of Internet-Based Cognitive Behavioral Therapy for Insomnia in Patients Prescribed Insomnia Medications; Identifier: NCT03313466; URL: https://clinicaltrials.gov/ct2/history/NCT03313466?V_1=View#StudyPageTop.
Keywords: cognitive-behavioral therapy; hybrid study design; insomnia; pragmatic study.
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. J Clin Sleep Med. 2021 Apr 28. doi: 10.5664/jcsm.9280. Epub ahead of print.