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2019 HSR&D/QUERI National Conference Abstract

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4139 — Insomnia Treatment Preferences in a Nationwide Sample of Women Veterans

Lead/Presenter: Gwendolyn Carlson,  COIN - Los Angeles
All Authors: Carlson GC (VA Greater Los Angeles Healthcare System, VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy), Martin JL (VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center), Grinberg AM (VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center) Altman L (VA Greater Los Angeles Healthcare System, VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy) Alessi CA (VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center) Washington DL (VA Greater Los Angeles Healthcare System, VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy) Yano EM (VA Greater Los Angeles Healthcare System, VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy)

Objectives:
It is estimated that more than half of women veterans receiving VA care meet diagnostic criteria for insomnia disorder. Additionally, women veterans prefer nonmedication treatment (e.g., Cognitive Behavioral Therapy for Insomnia [CBT-I]) more than medication treatment for insomnia; however, little is known about the context in which women veterans would prefer to receive CBT-I. The current project assessed women veterans' insomnia CBT-I-related treatment preferences.

Methods:
A large nationwide postal survey was sent to a random sample of 4,000 women veterans who received VA healthcare in the previous 6 months. In total, 1,559 completed surveys were returned. Items in the current analyses include: demographics, preferred clinic type, preferred provider type, importance of having a female provider (not at all important to very important), and likelihood of attending different CBT-I treatment formats (i.e., one-on-one in-person sessions, one-on-one telehealth sessions, women only groups, and coed groups; not at all likely to very likely).

Results:
Women veterans endorsed Primary Care (55.19%) and Women's Heath (54.6%) as their preferred clinics to receive insomnia treatment, followed by Sleep Medicine (40.21%), Mental Health (27.11%), and other locations (6.62%). Women veterans endorsed physicians (80.48%) as their preferred provider type, followed by nurses/nurse practitioners (37.09%), psychiatrists (32.56%), physician's assistants (28.86%), psychologists (27.11%), social workers (12.52%), and other providers (7.59%). In terms of having a female provider, 40.85% of women veterans reported this was somewhat important or very important. In terms of treatment format, 69.11% reported they would be very likely or somewhat likely to attend one-on-one in-person sessions, followed by one-on-one telehealth sessions (50.16%), women only groups (49.74%), and coed groups (35.51%).

Implications:
Women veterans prefer to receive insomnia treatment in Primary Care and Women's Health Clinics, prefer to be seen by physicians, and prefer a CBT-I one-one-one in-person treatment format.

Impacts:
While nationwide dissemination efforts have been made to train VA mental health providers in CBT-I, more efforts are needed to ensure that an adequate number of Women's Health Clinic providers are trained to deliver CBT-I to women veterans.