Preferred medications and behavioral treatment strategies identified in primary care patients with insomnia

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In a recent study of 200 patients at Virginia Commonwealth University (VCU) Medical Center and a community health clinic, primary care patients had a preference for medications and behavioral strategies in treatments for insomnia.1 Having greater alignment with the patient’s treatment preferences and actual method of treatment has the potential to be beneficial, as it can increase patient motivation, engagement, and treatment adherence.two

Among participants, 46.5% preferred medication and 56.0% of patients preferred behavioral treatment strategies for their insomnia. Additionally, behavioral treatment had the highest preference among those with severe insomnia (preferred, 15.2%; disliked, 4.5%; P =.002).

Co-author Bruce D. Rybarczyk, PhD, professor of clinical psychology, VCU, and colleagues noted, “The findings support the hypothesis that insomnia severity and mental health may be involved in treatment preference among primary care patients.” .1

The mean age of the participants was 54.92 (SD, 12.48) years. Those who were eligible for the study participated in screening for insomnia, depression, anxiety, and insomnia treatment preference. The Insomnia Severity Index measured insomnia symptoms, while the Patient Health Questionnaire 2 and the Generalized Anxiety Disorder 2 measured depressive and anxiety symptoms. Significant differences were assessed by χ2 analysis in preference between groups. The study sample had predominantly black patients from primary care settings, which is often an understudied and neglected insomnia patient population.

Overall, medication preference was higher in patients who had high levels of anxiety (preferred, 57.3%; upset, 42.7%; P =.017). In particular, preference for behavioral treatment (preferred, 66.7%; disliked, 33.3%; P =.012) and medication (preferred, 56.8%; disliked, 43.2%; P =.016) were highest among those with elevated depression. Treatment preference only differed by age for behavioral treatment (P =.008) as it was higher among patients younger than 51 years (preferred, 67.2%; disliked, 32.8%).

The researchers found that as mental health and sleep worsened, patients preferred behavioral treatment more. Another observation from the study was that older adults were significantly more likely to dislike behavioral treatment compared to younger adults who were more likely to prefer behavioral treatment.

“In addition, the proportion of preference for behavioral treatment and medication varied according to the level of depressive and anxiety symptoms,” Rybarczyk et al.1 “Knowledge of a patient’s treatment preference can facilitate shared decision-making, which increases patient satisfaction with care and commitment to treatment.”

Some limitations of the study included not having any information collected in terms of prior treatment experience and how those experiences may have influenced attitudes toward medication and behavioral treatment strategies. Another limitation was that the 2-item questionnaires measured treatment preference and mental health symptoms that might have resulted in an incomplete picture of them. In addition, patients’ preference choices may have been influenced by limited health knowledge or the need for more discussion of the treatment process along with supporting evidence for both methods.

Rybarczyk et al noted: “Taken together, these findings clarify some biases towards insomnia treatment approaches in patients receiving care in primary care settings and may suggest the need for clinical education regarding the evidence for insomnia treatment methods. insomnia and the distinctions between normal and abnormal sleep processes during aging. ”1

1. Pérez E, Donovan EK, Rybarczyk BD, Dzierzewski JM. Insomnia treatment preferences among primary care patients. clin ther. 2022;44(4):630-637. doi:10.1016/j.clinthera.2022.03.002
2. Cheung JM, Bartlett DJ, Armor CL, Saini B. Treatment of insomnia: a review of patients’ perceptions of treatment. Behavior Sleep Med. 2016;14(3):235-266. doi:10.1080/15402002.2014.981818

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