Abstract
Introduction
Use of telemedicine platforms for conducting CBTI has the potential to reach more patients than in person treatment alone. While CBTI has been shown to be effective in older adults, questions about proficiency with technology and preference for treatment modality have not been addressed.
Methods
Baseline data from participants in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study were used. Analyses compared CBTI treatment modality preference (in person, online [video platform], no preference) across the following variables: insomnia severity (Insomnia Severity Index; ISI), depression (Geriatric Depression Scale; GDS), cognitive functioning (telephone-based cognitive screen) and internet proficiency (IP; assessing comfort with and frequency of internet use). Data collected prior to the pandemic-shut down (March 2020) were utilized for the primary analysis of treatment preference; n=71, mean age = 62.5 (SD = 8.1); 64.8% female; treatment preferences: in person (33.8%), no preference (25.4%), online (40.8%). A secondary analysis compared IP data from participants with baseline data from pre-pandemic (Nov 2019-Feb 2020, n=71), early pandemic (March-June 2020, n=28), and late pandemic (the most recent four months of enrollment, July 2020-Nov 2020, n=40) periods.
Results
Pre-pandemic, age was not significantly associated with treatment modality preference, nor any baseline clinical characteristics or demographic variables (p’s >.01). Only ‘comfort’ and ‘comfort+frequency’ scores from the internet proficiency measure differed significantly between treatment preference groups (p’s<.002). Post-hoc analyses revealed the online group had significantly higher comfort and comfort+frequency scores than the in person group (p’s<. 003). Comparing data from pre-pandemic, early pandemic, and late pandemic, frequency of internet use and comfort+frequency with internet use differed across groups (p’s <.004). Post-hoc comparisons revealed frequency of internet use scores were higher in the late pandemic compared to pre-pandemic (p=.003).
Conclusion
These findings suggest that comfort using technology, but not age or clinical characteristics, is associated with treatment modality preference for patients with insomnia who are enrolled in a technology-based clinical trial of CBTI. As proficiency in use of technology increases, for example, during and following the pandemic, one can expect that telemedicine will be an increasingly viable approach to providing CBTI among older adults.
Support (if any)
1R01AG057500
Assessing the utility of the decoy effect on biologic treatment preference
