Abstract：
To characterize guideline-concordant use of cognitive behavioral therapy for insomnia vs. sleep medications among Veterans Health Administration patients.
Cognitive behavioral therapy for insomnia was identified from the text of psychotherapy notes within the Veterans Health Administration\'s electronic medical record. Patients that received first-line cognitive behavioral therapy for insomnia (ie, no prior insomnia treatment) were compared to those who first received a sleep medication in fiscal year 2021.
Among 5,519,016 patients, first-line cognitive behavioral therapy for insomnia was received by 9313 (0.2%) whereas 225,618 (4.1%) were newly prescribed a sleep medication without prior cognitive behavioral therapy for insomnia. Patients over 60 years old and those with substance use disorders were less likely to receive first-line cognitive behavioral therapy for insomnia compared to other patients.
Adherence to practice guidelines to provide cognitive behavioral therapy for insomnia as first-line treatment for insomnia disorder remains a challenge, highlighting the need to better integrate effective implementation strategies within therapist training programs. Targeted strategies may be needed for older patients or those with substance use disorders.
Cognitive behavioral therapy for insomnia was identified from the text of psychotherapy notes within the Veterans Health Administration\'s electronic medical record. Patients that received first-line cognitive behavioral therapy for insomnia (ie, no prior insomnia treatment) were compared to those who first received a sleep medication in fiscal year 2021.
Among 5,519,016 patients, first-line cognitive behavioral therapy for insomnia was received by 9313 (0.2%) whereas 225,618 (4.1%) were newly prescribed a sleep medication without prior cognitive behavioral therapy for insomnia. Patients over 60 years old and those with substance use disorders were less likely to receive first-line cognitive behavioral therapy for insomnia compared to other patients.
Adherence to practice guidelines to provide cognitive behavioral therapy for insomnia as first-line treatment for insomnia disorder remains a challenge, highlighting the need to better integrate effective implementation strategies within therapist training programs. Targeted strategies may be needed for older patients or those with substance use disorders.
摘要：
目的：描述认知行为疗法与失眠症的指南一致使用退伍军人健康管理局患者的睡眠药物。
方法：失眠症的认知行为疗法是从退伍军人健康管理局电子病历中的心理治疗说明中确定的。接受失眠一线认知行为治疗的患者（即，之前没有失眠治疗)与2021财年首次接受睡眠药物治疗的人进行比较。
结果：在5,519,016例患者中，9313人(0.2%)接受了失眠的一线认知行为治疗,而225,618人(4.1%)在没有接受失眠认知行为治疗的情况下接受了睡眠药物的新处方.与其他患者相比，60岁以上的患者和患有物质使用障碍的患者不太可能接受失眠的一线认知行为治疗。
结论：坚持实践指南，为失眠提供认知行为疗法作为失眠障碍的一线治疗仍然是一个挑战，强调需要在治疗师培训计划中更好地整合有效的实施策略。老年患者或有物质使用障碍的患者可能需要针对性的策略。
方法：失眠症的认知行为疗法是从退伍军人健康管理局电子病历中的心理治疗说明中确定的。接受失眠一线认知行为治疗的患者（即，之前没有失眠治疗)与2021财年首次接受睡眠药物治疗的人进行比较。
结果：在5,519,016例患者中，9313人(0.2%)接受了失眠的一线认知行为治疗,而225,618人(4.1%)在没有接受失眠认知行为治疗的情况下接受了睡眠药物的新处方.与其他患者相比，60岁以上的患者和患有物质使用障碍的患者不太可能接受失眠的一线认知行为治疗。
结论：坚持实践指南，为失眠提供认知行为疗法作为失眠障碍的一线治疗仍然是一个挑战，强调需要在治疗师培训计划中更好地整合有效的实施策略。老年患者或有物质使用障碍的患者可能需要针对性的策略。
