Differences between patients' and clinicians' report of sleep disturbance: a field study in mental health care in Norway

<p>Abstract</p> <p>Background</p> <p>The aims of the study was to assess the prevalence of diagnosed insomnia and the agreement between patient- and clinician-reported sleep disturbance and use of prescribed hypnotic medication in patients in treatment for mental disorders.</p> <p>Methods</p> <p>We used three cross-sectional, multicenter data-sets from 2002, 2005, and 2008. Data-set 1 included diagnostic codes from 93% of all patients receiving treatment in mental health care in Norway (<it>N </it>= 40261). Data-sets 2 (<it>N </it>= 1065) and 3 (<it>N </it>= 1181) included diagnostic codes, patient- and clinician-reported sleep disturbance, and use of prescribed hypnotic medication from patients in 8 mental health care centers covering 10% of the Norwegian population.</p> <p>Results</p> <p>34 patients in data-set 1 and none in data-sets 2 and 3 had a diagnosis of insomnia as a primary or comorbid diagnosis. In data-sets 2 and 3, 42% and 40% of the patients reported sleep disturbance, whereas 24% and 13% had clinician-reported sleep disturbance, and 7% and 9% used hypnotics. Patients and clinicians agreed in 29% and 15% of the cases where the patient or the clinician or both had reported sleep disturbance. Positive predictive value (PPV) of clinicians' evaluations of patient sleep disturbance was 62% and 53%. When the patient reported sleep disturbance as one of their most prominent problems PPV was 36% and 37%. Of the patients who received hypnotic medication, 23% and 29% had neither patient nor clinician-rated sleep disturbance.</p> <p>Conclusion</p> <p>When patients meet the criteria for a mental disorder, insomnia is almost never diagnosed, and sleep disturbance is imprecisely recognized relative to the patients' experience of sleep disturbance.</p

Community-Based Operations Research: Introduction, Theory and Applications

Community-based operations research is the name of a new sub-discipline within operations research and the management sciences. CBOR synthesizes previous practice and research traditions within OR/MS to address problems within the public sector that are often of a localized nature, that address the concerns of citizens affiliated through characteristics of race, ethnicity and class and other ties and that are solved using diverse qualitative and quantitative methods. Solutions to these problems are developed and implemented by formal and informal organizations, and embody a critical perspective towards traditional notions of decisionmakers, stakeholders and analytic methods. The most proximate antecedents of CBOR are the well-studied fields of community operational research, problem structuring methods and soft systems methodologies. This chapter provides a framework for understanding CBOR through key themes such as the importance of place and space, community, disadvantaged populations and multiple methods. It introduces a theory of CBOR, surveys recent literature within CBOR and assesses the presence of CBOR in OR/MS literature, education and practice. After a summary of this book‘s twelve chapters, eleven of which are newly published, the introduction concludes by summarizing the important contributions of CBOR and identifies some promising avenues for future research