Daniel Bluestein

Psychologists and Primary Care Physicians: A Training Model for Creating Collaborative Relationships

For over a decade insurance reform, changes in health care delivery, reimbursement policies, and managed care have increased pressure on psychologists to diversify beyond traditional practices. Despite the negative impact of failing to make a transformation, most psychologists have not modified their practice and most training programs do not prepare psychologists to provide integrated care. The current paper describes the importance of primary care and psychology partnering to create integrated care models and makes the case that such partnerships are not only beneficial to patients but to both professions. The paper concludes with a description of a training model that has been implemented at the institution of the authors that provides opportunities for psychologists to learn how to practice in primary care settings.

Psychosocial Correlates of Insomnia Severity in Primary Care

Purpose: Insomnia is a substantive primary care issue that leads to adverse outcomes. These can be improved by addressing factors that accentuate insomnia severity. Accordingly, this study identifies correlates of insomnia severity and determines whether these relationships vary with sociodemographic attributes. Methods: This correlational cross-sectional study was conducted in a hospital-sponsored primary care clinic and 2 urban, academic family practice centers. Participants consisted of 236 patients 18 years old or older with clinically significant insomnia (Insomnia Severity Index scores of 7 or more). Surveys instruments included the Insomnia Severity Index, SF-8 (Medical Outcomes Study SF-8 global health status measure), CES-D (Center for Epidemiologic Studies-Depression Scale), DBAS (Dysfunctional Beliefs about Sleep scale), SE-S (Self-Efficacy for Sleep Scale), and a researcher-designed demographic survey. Analytic techniques included descriptive statistics to characterize the study sample, Pearson or Spearman Correlation Coefficients to examine individual associations with insomnia severity, and step-wise linear regression to identify net predictors. Results: Insomnia severity was significantly correlated with health status, depression, self-efficacy, and dysfunctional beliefs (P < .001) but not with sociodemographic attributes. Linear regression demonstrated insomnia severity was best predicted by low self-efficacy and high depression scores. Discussion: These findings indicate that clinicians treating insomnia should not only manage comorbid depression but also facilitate self-efficacy for sleep-inducing behavioral change.

Acceptability of Behavioral Treatments for Insomnia

Background: Behavioral treatments for insomnia are safe and efficacious but may not be embraced by patients in primary care. Understanding factors associated with acceptability can enhance successful use of these modalities. The objective of this study was to identify demographic and clinical/psychosocial correlates of behavioral insomnia treatment acceptability. Methods: This nonexperimental, inventory-based, cross-sectional study enrolled patients from a hospital-sponsored primary care clinic and 2 urban academic family practices. Participants (n = 236) were 18 years of age or older who had clinically significant insomnia (Insomnia Severity Index score ≥ 8) and were recruited consecutively at these sites. A study coordinator obtained informed consent then distributed survey materials. Participants received a

Predictors of self-efficacy for sleep in primary care.

10 honorarium. The main outcome measure was the Acceptability Insomnia Treatment Acceptability Scale-Behavioral subscale (ITAS-B). Results: Only acceptability of medications (r = 0.259) and dysfunctional beliefs (r = 0.234) scores had significant bivariate correlations with ITAS-B scores (P < .001). Medication acceptability, dysfunctional beliefs, and self-efficacy accounted for 12.45% of ITAS-B variance in linear regression. Conclusions: Screening for dysfunctional beliefs about sleep may identify patients with interest in behavioral approaches. Improving self-efficacy for sleep may improve acceptance of behavioral insomnia therapies. Interest in behavioral and medication treatments are not mutually exclusive. However, the modest variance reported here suggests other factors impact acceptance of behavioral treatments.

Validation of the Insomnia Treatment Acceptability Scale (ITAS) in Primary Care

AIMS AND OBJECTIVES To identify factors impacting self-efficacy for sleep. Specifically, the aims were to examine associations between self-efficacy for sleep and (1) socio-demographic variables and (2) potential predictors including sleep severity, depression, dysfunctional beliefs about sleep, quality of life/health status and insomnia treatment acceptability for behavioural treatment. BACKGROUND Between 50 and 70 million Americans experience insomnia. Costs of treatment, absenteeism and reduced productivity exceed 42 billion dollars annually. Medication for insomnia can result in impaired memory, fatigue, injuries, reduced health, medication habituation, difficulties in work and relationships and enhanced healthcare usage. Studies have suggested that behavioural management can be beneficial; however, factors contributing to success with behavioural management are unclear. DESIGN This quantitative correlational study used inventory-based measures. METHODS The Self-Efficacy for Sleep Scale, Insomnia Treatment Acceptability Scale, SF-8™ Health Survey, Center for Epidemiological Studies Depression Scale and Dysfunctional Beliefs about Sleep Scale were completed by 236 individuals with significant insomnia as measured by Insomnia Severity Index scores of 8 or higher. RESULTS A significant association was found between sleep self-efficacy and race (p < 0·01). All predicator variables except one were found to be significantly correlated with the self-efficacy for sleep (p < 0·01). CONCLUSIONS For behavioural self-management strategies to be effective for treating insomnia, these reported predictors may need to be assessed and managed. RELEVANCE TO CLINICAL PRACTICE These findings suggest that nurses may want to assess insomnia severity, health status, level of depression and beliefs about sleep prior to beginning or when encountering barriers to the successful utilisation of behavioural approaches to manage sleep. If a patient is found to possess these limiting factors, the nurse may want to address these issues through medication, education and/or other behavioural approaches. Once addressed, the patient may find behavioural management for insomnia to be quite successful.

Re: Sleep and the Family Doctor: Time to Lead

Patients with insomnia respond best to cognitive-behavioral treatments (CBT) if they find the approach acceptable. One tool, the Insomnia Treatment Acceptability Scale (ITAS), has been used to identify such patients, however, its reliability and validity has not been well established especially in primary care. The purpose of this study was to assess the reliability and validity of the ITAS in a primary care setting. A cross-sectional survey was conducted with 236 primary care patients, aged 18 and above, with clinically significant insomnia (Insomnia Severity Index ≥8). Descriptive and summary statistics, Cronbach’s alpha, Principal Axis Factor analysis with Promax rotation, and comparison of ITAS subscale scores with self-reported treatment preferences (Chi-Square) are included. Factor analysis identified two factor solutions for the ITAS subscales. The ITAS was shown to be a reliable and valid tool that can be used to facilitate psychological practice and research on interdisciplinary behavioral-medical care.

Predicting the occurrence of antibiotic-induced candidal vaginitis (AICV).

To the Editor: We have read with interest Dr. Sorschers[1][1] commentary in the March-April 2011 issue of the Journal of the American Board of Family Medicine . We concur strongly with his assertions that sleep and sleep disorders are an important and under-recognized primary care domain. He