Abstract

Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment in adults. However, access to care is limited. One potential solution is telemedicine. Though synchronous video-based telemedicine CBT-I has been shown to be non-inferior to in-person treatment, there is no study to date that evaluates patient and provider experiences with video-based treatment. Our study team evaluated patient and provider perceptions of CBT-I delivered via telemedicine versus an in-person format. As part of a larger randomized control trial, we interviewed patients and providers in both arms of the study (in-person and via telemedicine). 20 minute interviews were conducted over the phone and were transcribed and coded to identify themes. While patients shared initial concerns about telemedicine CBT-I, including privacy and technological issues, they were satisfied with the approach and had similar experiences as the patients receiving in-person treatment. Providers shared concerns about challenges establishing a strong therapeutic alliance, patient engagement, and accountability in CBT-I, but felt these did not interfere with their overall ability to deliver care. Patients and providers were satisfied with CBT-I treatment delivered via telemedicine when compared to those being treated in-person. Patients in both arms noted that virtual care could increase access and provide convenience.

摘要

失眠的认知行为疗法（CBT-I）是一种有效的成人治疗方法。然而，获得护理的机会是有限的。一种潜在的解决方案是远程医疗。尽管基于同步视频的远程医疗 CBT-I 已被证明不劣于亲自治疗，但迄今为止还没有研究评估患者和提供者对基于视频的治疗的体验。我们的研究团队评估了患者和提供者对通过远程医疗与面对面形式提供的 CBT-I 的看法。作为一项更大的随机对照试验的一部分，我们采访了研究的两个分支（面对面和通过远程医疗）的患者和提供者。通过电话进行了 20 分钟的采访，并被转录和编码以确定主题。虽然患者最初对远程医疗 CBT-I 表示担忧，包括隐私和技术问题，他们对这种方法感到满意，并且与接受面对面治疗的患者有相似的经历。提供者对在 CBT-I 中建立强大的治疗联盟、患者参与和问责制的挑战表示担忧，但认为这些不会影响他们提供护理的整体能力。与亲自接受治疗的患者相比，患者和提供者对通过远程医疗提供的 CBT-I 治疗感到满意。两组患者都指出，虚拟护理可以增加访问量并提供便利。但认为这些并没有影响他们提供护理的整体能力。与亲自接受治疗的患者相比，患者和提供者对通过远程医疗提供的 CBT-I 治疗感到满意。两组患者都指出，虚拟护理可以增加访问量并提供便利。但认为这些并没有影响他们提供护理的整体能力。与亲自接受治疗的患者相比，患者和提供者对通过远程医疗提供的 CBT-I 治疗感到满意。两组患者都指出，虚拟护理可以增加访问量并提供便利。