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Sleep. 2016 Jan 1;39(1):237-47. doi: 10.5665/sleep.5356.

A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial.

Author information

1
National Jewish Health, Denver, CO.
2
Duke University Medical Centers, Durham, NC.
3
VA, Durham, NC.

Abstract

OBJECTIVES:

To test a collaborative care model for interfacing sleep specialists with primary care providers to enhance patients' sleep disorders management.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

A one-time sleep consultation significantly increased healthcare providers' attention to sleep problems and resulted in benefits to patients' sleep/wake symptoms.

CLINICAL TRIALS REGISTRATION:

This study is registered with clinicaltrials.gov with identifier # NCT00390572.

KEYWORDS:

collaborative care; primary and specialty care; sleep disorders

PMID:
26285003
PMCID:
PMC4678353
DOI:
10.5665/sleep.5356
[Indexed for MEDLINE]
Free PMC Article

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