scholarly journals Faculty Opinions recommendation of Provider perspectives of implementation of an evidence-based insomnia treatment in Veterans Affairs (VA) primary care: barriers, existing strategies, and future directions.

2022 ◽  
Author(s):  
Michael Perlis
Keyword(s):  
Primary Care ◽  
Veterans Affairs ◽  
Evidence Based ◽  
Future Directions ◽  
Provider Perspectives ◽  
Insomnia Treatment

scholarly journals Provider perspectives of implementation of an evidence-based insomnia treatment in Veterans Affairs (VA) primary care: barriers, existing strategies, and future directions

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Erin Koffel ◽  
Hildi Hagedorn
Keyword(s):  
Primary Care ◽  
Veterans Affairs ◽  
Opinion Leaders ◽  
Assessment Process ◽  
Health Concern ◽  
Evidence Based ◽  
Health Administration ◽  
Provider Perspectives ◽  
Increased Risk ◽  
Insomnia Treatment

Abstract Background Cognitive behavioral therapy for insomnia (CBT-I) is a highly effective nonpharmacological intervention that is widely considered the gold standard for insomnia treatment. Insomnia is a prevalent and debilitating public health concern. Up to one third of the general population struggles with chronic insomnia, greatly increasing the risk for chronic pain and inflammation, depression and suicide, and cognitive decline. Over the last 10 years, the Veterans Health Administration (VHA) evidence-based psychotherapy training program has trained nearly 1000 providers to deliver CBT-I in hospitals and clinics nationwide. Despite increased access, most patients with insomnia receive sleeping medications instead of CBT-I. This is particularly concerning for vulnerable populations, like older adults, who may be at increased risk of harms from medications. The goal of this study was to obtain a broad range of perspectives on CBT-I implementation from providers who commonly utilize and deliver CBT-I. This work identifies barriers and successful strategies used to overcome these barriers to guide future implementation efforts promoting evidence-based sleep care. Methods Semi-structured interviews, using the Consolidated Framework for Implementation Research (CFIR) as a guide, were conducted with 17 providers from five Veterans Affairs (VA) facilities (8 primary care physicians, 4 primary care psychologists, and 5 CBT-I coordinators). We used a thematic analysis approach in which common ideas were identified across interviews and then grouped into larger conceptual themes. Data were concurrently collected and analyzed with rapid assessment process (RAP) techniques. Results Findings suggested implementation barriers and facilitators related to the CFIR constructs of intervention characteristic (e.g., providers unfamiliar with primary evidence of CBT-I effectiveness), inner setting (e.g., sleep as a low relative priority in primary care), and outer setting (e.g., lack of external incentives for increasing CBT-I use), as well as several successful strategies, including use of local champions and supportive opinion leaders. Conclusions These findings suggest promising opportunities to improve implementation of CBT-I, especially at facilities with less well-established CBT-I programs. Formal implementation trials are needed to systematically determine the real-world impact of strategies such as enlisting CBT-I champions, informing opinion leaders about CBT-I services, and promoting network weaving among primary care, mental health, and sleep clinics.

scholarly journals Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

2017 ◽  
Vol 13 (08) ◽  
pp. 991-999 ◽  
Author(s):  
Christi S. Ulmer ◽  
Hayden B. Bosworth ◽  
Jean C. Beckham ◽  
Anne Germain ◽  
Amy S. Jeffreys ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Veterans Affairs ◽  
Provider Perceptions ◽  
Insomnia Treatment

Forgiveness: Moving on can be healthy

2019 ◽  
Vol 55 (2) ◽  
pp. 123-130
Author(s):  
John F Clabby
Keyword(s):  
Primary Care ◽  
Social Workers ◽  
Positive Relationship ◽  
Physical Therapists ◽  
Case Managers ◽  
Evidence Based ◽  
Future Directions ◽  
Medical Assistants ◽  
Forgiveness Therapy ◽  
Primary Care Clinicians

Forgiveness as a procedure has been gaining prominence. The objective of this article is to provide the basics of forgiveness as an intervention so primary care clinicians can facilitate its use. These clinicians include but are not limited to physicians, nurses, medical assistants, pharmacy professionals, physical therapists, social workers, psychologists, case managers, and clergy. This narrative explains the rationale for understanding forgiveness as a procedure and ways to explain it. To assist clinicians and patients in making informed decisions, samples of forgiveness research are included that describe its positive relationship to specific physical health situations. The article also describes an evidence-based forgiveness therapy, circumstances in which it is harmful to forgive oneself or others, describes the limitations of this article, and suggests future directions.

Insomnia Treatment Experience and Preferences Among Veterans Affairs Primary Care Patients

2014 ◽  
Vol 179 (10) ◽  
pp. 1072-1076 ◽  
Author(s):  
Robyn L. Shepardson ◽  
Jennifer S. Funderburk ◽  
Wilfred R. Pigeon ◽  
Stephen A. Maisto
Keyword(s):  
Primary Care ◽  
Veterans Affairs ◽  
Treatment Experience ◽  
Primary Care Patients ◽  
Insomnia Treatment

Association between frequency of primary care provider visits and evidence-based statin prescribing and statin adherence: Findings from the Veterans Affairs system

2020 ◽  
Vol 221 ◽  
pp. 9-18 ◽  
Author(s):  
Sarah T. Ahmed ◽  
Dhruv Mahtta ◽  
Hasan Rehman ◽  
Julia Akeroyd ◽  
Mahmoud Al Rifai ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Veterans Affairs ◽  
Evidence Based ◽  
Statin Adherence

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Measurement-based care implementation in a Veterans Affairs primary care–mental health integration program.

2020 ◽  
Vol 17 (3) ◽  
pp. 323-331
Author(s):  
Daniel A. Goldstein ◽  
Katherine Meyers ◽  
Maurice Endsley ◽  
Erin O. Zerth
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Veterans Affairs ◽  
Primary Care Mental Health ◽  
Integration Program ◽  
Measurement Based Care ◽  
Mental Health Integration
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