Effectiveness and cost-effectiveness of an educational intervention for practice teams to deliver problem focused therapy for insomnia: rationale and design of a pilot cluster randomised trial

Background: Sleep problems are common, affecting over a third of adults in the United Kingdom and leading to reduced productivity and impaired health-related quality of life. Many of those whose lives are affected seek medical help from primary care. Drug treatment is ineffective long term. Psychological methods for managing sleep problems, including cognitive behavioural therapy for insomnia (CBTi) have been shown to be effective and cost effective but have not been widely implemented or evaluated in a general practice setting where they are most likely to be needed and most appropriately delivered. This paper outlines the protocol for a pilot study designed to evaluate the effectiveness and cost-effectiveness of an educational intervention for general practitioners, primary care nurses and other members of the primary care team to deliver problem focused therapy to adult patients presenting with sleep problems due to lifestyle causes, pain or mild to moderate depression or anxiety. Methods and design: This will be a pilot cluster randomised controlled trial of a complex intervention. General practices will be randomised to an educational intervention for problem focused therapy which includes a consultation approach comprising careful assessment (using assessment of secondary causes, sleep diaries and severity) and use of modified CBTi for insomnia in the consultation compared with usual care (general advice on sleep hygiene and pharmacotherapy with hypnotic drugs). Clinicians randomised to the intervention will receive an educational intervention (2 × 2 hours) to implement a complex intervention of problem focused therapy. Clinicians randomised to the control group will receive reinforcement of usual care with sleep hygiene advice. Outcomes will be assessed via self-completion questionnaires and telephone interviews of patients and staff as well as clinical records for interventions and prescribing. Discussion: Previous studies in adults have shown that psychological treatments for insomnia administered by specialist nurses to groups of patients can be effective within a primary care setting. This will be a pilot study to determine whether an educational intervention aimed at primary care teams to deliver problem focused therapy for insomnia can improve sleep management and outcomes for individual adult patients presenting to general practice. The study will also test procedures and collect information in preparation for a larger definitive cluster-randomised trial. The study is funded by The Health Foundation

Adaptable buildings for sustainable built environment

Purpose – The purpose of this paper is to explore the ability of “adaptable buildings” to respond to future potential built environment changes in sustainable way. Design/methodology/approach – A detailed literature review and a case study were undertaken to identify the life cycle changes of typical buildings over a period of more than 100 years. In total, 12 semi-structured interviews were conducted among construction industry professionals to identify how adaptable buildings enhance sustainability within the built environment. Case study data were analysed through a Morphological Analysis, and the interview data were analysed through discourse analysis. Findings – Out of the many adaptable features, the results revealed “change of use” as the dominant trend within the buildings of the selected urban cluster. More than 60 per cent of buildings have changed their original use during their life cycle. Around 10 per cent of them have changed their use frequently (every six year) during the last 20 years thereby signalling an increase in the rate of change. The positive contribution of adaptable buildings in achieving sustainability in terms of economic, social and environmental considerations, were confirmed through the analysis of semi-structured interviews. Originality/value – This paper reports a longitudinal study spanning over 100 years, exploring the extent of building adaptation within a selected cluster of Liverpool city centre, UK. The study further confirms the need to incorporate adaptability as a key criterion when designing buildings. The increased rate at which “change of use” has occurred further reinforces the need. Lack of a track record of designing for reuse makes this an interesting challenge for the construction industry, hence likely to have significant implications for policy/strategy formulation