Adapting an Evidence-Based Insomnia Practice Guideline for Use in a University Healthcare Setting
Repository Posting Date2018-07-03T14:16:47Z
Author(s)Denny, Maria M.
TypeDNP Capstone Project
Level of EvidenceOther
Research ApproachTranslational Research/Evidence-based Practice
CINAHL HeadingsInsomnia--Therapy; Cognitive Therapy--Methods; Practice Guidelines; Program Implementation; Student Health Services; Professional Practice, Evidence-Based; Insomnia; Cognitive Therapy
Recent evidence-based practice guidelines (EBPGs) recommend cognitive-behavioral therapy for insomnia (CBT-I) as first-line treatment for adults with chronic insomnia, with pharmacotherapy as a secondary option. Pharmacotherapy is often used in primary care settings, which have limited access to specialty CBT-I services. Proven lower-intensity CBT-I components and delivery modes can be customized for primary care.The purpose of this DNP project was to adapt an insomnia EBPG for use at a university health service with integrated primary care and mental health resources. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided this project, involving primary care and mental health providers in decision-making about guideline adaptation. A Plan-Do-Study-Act (PDSA) cycle included provider education, guideline tool development, and implementation of CBT-I client education and referral. A pre- and post-survey design used the Organizational Readiness to Change Assessment (ORCA) to assess providers’ perspectives on the evidence, context, and facilitation strategies. Aggregate clinical data was used to measure changes in CBT-I referrals and insomnia prescriptions.ORCA responses indicate providers’ readiness to implement insomnia EBP change based on the new clinical tools, project context, and facilitation strategies, without a significant change pre- to post-survey. Also, clinical data did not detect a significant change in CBT-I referrals or insomnia prescriptions. Further PDSA cycles are recommended to refine implementation of evidence-based insomnia care, using mixed data collection methods for more detailed evaluation.