Literature Collection

BACKGROUND: Sleepio, a digital therapeutic offering digital cognitive behavioral therapy for insomnia, has been recommended by the National Institute for Health and Care Excellence in the United Kingdom as an alternative to offering sleep hygiene or sleeping pills. However, understanding of the referral behavior of general practitioners (GPs) regarding Sleepio is lacking. OBJECTIVE: The aim of this study was to investigate the feasibility of using an intervention targeting GPs in Scotland to increase referrals of patients with insomnia to Sleepio. METHODS: GPs working in primary care in Scotland were invited to join the study. GPs were recruited through the Primary Care Research Network in Scotland from June 10, 2024, to October 13, 2024. The behavior change wheel (BCW) was used to inform the design of the intervention. During the intervention, GPs reviewed an orientation on using Sleepio and received a visual reminder midway through the intervention. The primary outcome was the number of Sleepio referrals every 2 weeks over 2 months. The secondary outcome was the change in the GPs' reported confidence level that Sleepio will be successful in reducing patients' insomnia symptoms, and confidence in recommending Sleepio to patients. RESULTS: Of the 23 GPs who joined the study, 16 completed all stages. Overall, 68.8% (11/16) of participants were females, and the mean age was 42 (SD 8) years. The total number of Sleepio referrals in 2 months was 96 for all 16 GPs. In the first 2 weeks of the intervention, the mean referral rate to Sleepio was 22.4% for all 16 GPs, but this rate increased to 45% by the end of week 8. A repeated measures analysis indicated there was no statistically significant difference in GPs' referral rates across 4 data points. GPs' reported confidence level in recommending Sleepio increased significantly (z=-3.436; P<.001), from a mean of 5.44 (SD 1.7; somewhat confident) to 8.13 (SD 2; very confident). CONCLUSIONS: This study explored the feasibility and impact of an intervention aimed at supporting GPs to refer patients with insomnia to the digital therapeutic, Sleepio. Improvements were seen in GP-reported confidence levels at recommending Sleepio. A large-scale intervention and a longer study duration could provide useful information concerning how long the intervention effect on GPs' behavior toward Sleepio referrals might be maintained.

BACKGROUND: There may be less primary health care engagement among people who use drugs (PWUD) than among the general population, even though the former have greater comorbidity and more frequent use of emergency department care. We investigated factors associated with primary care engagement among PWUD. METHODS: The Participatory Research in Ottawa: Understanding Drugs (PROUD) cohort study meaningfully engaged and trained people with lived experience to recruit and survey marginalized PWUD between March-December 2013. We linked this survey data to provincial-level administrative databases held at ICES. We categorized engagement in primary care over the 2 years prior to survey completion as: not engaged (< 3 outpatient visits to the same family physician) versus engaged in care (3+ visits to the same family physician). We used multivariable logistic regression to determine factors associated with engagement in primary care. RESULTS: Characteristics of 663 participants included a median age of 43 years, 76% men, and 67% living in the two lowest income quintile neighborhoods. Despite high comorbidity and a median of 4 (interquartile range 0-10) primary care visits in the year prior to survey completion, only 372 (56.1%) were engaged in primary care. Engagement was most strongly associated with the following factors: receiving provincial benefits, including disability payments (adjusted odds ratio [AOR] 4.14 (95% confidence interval [CI] 2.30 to 7.43)) or income assistance (AOR 3.69 (95% CI 2.00 to 6.81)), having ever taken methadone (AOR 3.82 (95% CI 2.28 to 6.41)), mental health comorbidity (AOR 3.43 (95% CI 2.19 to 5.38)), and having stable housing (AOR 2.09 (95% CI 1.29 to 3.38)). CONCLUSIONS: Despite high comorbidity, engagement in primary care among PWUD was low. Our findings suggest that social care (housing, disability, and income support) and mental health care are associated with improved primary care continuity; integration of these care systems with primary care and opioid substitution therapy may lessen the significant morbidity and acute care use among PWUD.