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Abstract Introduction Despite Cognitive Behavioral Therapy for Insomnia (CBT-I) being first line treatment for insomnia, primary care physicians typically treat insomnia with sleep hygiene or pharmacotherapy, but are unsatisfied with these approaches (Ulmer et al., 2017). Physicians may also lack knowledge about CBT-I (Dyas et al., 2010), or find it difficult to refer patients to receive therapist-delivered treatment due to a lack of trained providers (Haycock et al., 2021). Fully automated (without therapist support) digital CBT-I provides a solution with immediate, standardized, and convenient access for patients. This implementation project aims to embed evidenced-based digital treatment (Sleepio) in real world clinical practice within a large health care system (Henry Ford Health) and evaluate a novel clinical workflow. Methods Patients with insomnia who may benefit from CBT-I determined by their treating practitioner are offered Sleepio via the Epic electronic health records system at HFH Academic Internal Medicine (AIM) and Sleep clinics. Normalization Process Theory (May et al., 2016) was used to provide a framework to help embed digital CBT-I access. We report rates of electronic orders and Sleepio sign-ups for implementation and workflow acceptability. Leaflets and digital assets were distributed. Training sessions were also provided for clinicians at both the AIM and Sleep clinics. Email reminders helped promote access over time. Results As of December 13, 2023, N=565 electronic orders were placed by treating practitioners, and n=214 (38%) patients signed-up to start Sleepio (n=140 female, mean age=52.9 range: 18-88). The majority (84%) of patients were from sleep clinics. Adapting the electronic order process enabled clinicians to provide immediate digital access for patients. Senior staff training sessions at the sleep clinics were associated with a higher order rate across the Sleep clinics compared with the AIM clinic. Conclusion Fully-automated digital CBT for insomnia can be delivered as part of routine clinical care and electronic workflows with limited disruption to clinical practice. Normalization Process Theory enabled low-lift non-disruptive changes to clinical workflow over time allowing patients to obtain access to Sleepio. Training and reminding clinicians on how to introduce patients to a digital treatment helped increase uptake. Support (if any) n/a
Miller et al. (Sat,) studied this question.