Introduction: Insomnia is a common complaint among primary care patients that can have significant consequences for physiological and mental health. Although psychopharmacological interventions have traditionally been taught as first-line treatment in medical education, cognitive behavioral therapy (CBT) for insomnia has emerged as the recommended treatment to address the multimodal precipitants and reinforcing factors of insomnia symptoms.
Methods: We developed a 90-minute workshop that included a didactic component to deliver content, role-playing to practice skills, and discussion to reflect and solidify learning. Two facilitators, a general internist and a clinical psychologist with content expertise in CBT, delivered the workshop to 16 internal medicine residents. This pairing provided complementary perspectives to allow for learner engagement. To evaluate the workshop, we used a pre/post survey that was administered at the beginning of the workshop and at its end. Participants were asked how often they incorporated (presurvey) and intended to incorporate (postsurvey) CBT as part of treatment of insomnia in their clinical practices.
Results: Sixteen internal medicine residents participated in the workshop and completed the pre/post survey. Our results showed immediate positive outcomes as a result of participating in the workshop.
Discussion: Our results showed that participants increased their intent to incorporate CBT in their primary care practice and increased their comfort with the various components of CBT. Our future directions include examining how long-term behavior changes as a result of this training.
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http://dx.doi.org/10.15766/mep_2374-8265.11002 | DOI Listing |
Am J Manag Care
January 2025
Health Economics Resource Center, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA 94025. Email:
Objectives: Unused medical appointments affect both patient care and clinic operations, and the frequency of cancellations due to clinic reasons is underreported. The prevalence of these unused appointments in primary care in the Veterans Affairs Health Care System (VA) is unknown. This study examined the prevalence of unused primary care appointments and compared the relative frequency of cancellations and no-shows for patient and clinic reasons.
View Article and Find Full Text PDFAm J Manag Care
January 2025
Schaeffer Center for Health Policy & Economics, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, Los Angeles, CA 90089. Email:
Objectives: To assess trends in the medical loss ratio (MLR) and understand how health insurance premiums in the large group market are driven by medical claims spending and insurer margins.
Study Design: Study of approximately 500 insurers covering more than 40 million lives annually in the large group market that submitted an MLR submission form (2014-2022).
Methods: We assessed trends in the MLR, premiums, medical claims spending, administrative costs, quality improvement spending, and margins among all insurers in the large group market.
Am J Manag Care
January 2025
Ascension Borgess Hospital, 345 Naomi St, Plainwell, MI 49080. Email:
Objective: To describe the outcomes of a partnership between a drug plan and pharmacists to switch patients from brand name dipeptidyl-peptidase-4 inhibitors to the generic alogliptin.
Study Design: Single-center, retrospective chart review.
Methods: Clinical pharmacists contacted patients with primary care providers within the health system affiliated with the drug plan to facilitate the switch.
Am J Manag Care
January 2025
Department of Orthopedic Surgery, Duke University School of Medicine, 311 Trent Dr, Durham, NC 27710. Email:
Objectives: Patients are often discharged to a skilled nursing facility (SNF) for postacute rehabilitation. Functional outcomes achieved in SNFs are variable, and costs are high. Especially for accountable care organizations (ACOs), home-based postacute rehabilitation offers a high-value option if outcomes are not compromised.
View Article and Find Full Text PDFJ Med Internet Res
January 2025
Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
Background: The aging global population and the rising prevalence of chronic disease and multimorbidity have strained health care systems, driving the need for expanded health care resources. Transitioning to home-based care (HBC) may offer a sustainable solution, supported by technological innovations such as Internet of Medical Things (IoMT) platforms. However, the full potential of IoMT platforms to streamline health care delivery is often limited by interoperability challenges that hinder communication and pose risks to patient safety.
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