Implementing an Insomnia Assessment and Management Algorithm in a Rural Pirmary Care Clinic

Abstract

Insomnia is the most common sleep complaint and significantly impacts quality of life and productivity. The accumulated total of direct and indirect healthcare costs related to insomnia is estimated to be as high as $100 billion/year and is associated with an increased risk of cardiovascular and cerebrovascular disease. Primary care providers play a critical role in identifying and implementing early interventions to address insomnia. However, this can be time-consuming, and providers may be unaware of the latest treatment guidelines and available resources. This project provided a research-based algorithm to identify and initiate treatment for patients 18+ with chronic insomnia in a rural primary care clinic in central Illinois. The project was implemented starting with a CME provider presentation surrounding researched-based treatment guidelines for insomnia management. An Epic “smart phrase” was created to be utilized in provider notes to guide management. Additionally, patient/provider resources were developed to support the algorithm. A direct referral was facilitated to a clinical psychologist for CBTi for patients with chronic insomnia. There was a 15% increase in Sleep Medicine referrals from the previous year during the same time interval and four direct referrals for CBTi for patients with severe insomnia. Providers noted that they found the education meaningful and adapted recommendations to their practice. The project benefited both providers and patients by delivering safe and efficient care for the substantial number of patients who experience chronic insomnia