1067 Increasing Access to Behavioral Insomnia Care: A Hybrid Implementation-Effectiveness Trial

Abstract Introduction Chronic insomnia is common among Veterans and contributes to poor health and quality of life. To improve access to care, Brief Behavioral Treatment for Insomnia (BBTI) was developed for delivery outside of specialty care settings. BBTI is a brief, flexible, and effective adaptation of CBT-I. However, training alone is rarely sufficient for sustainable change and implementation strategies are needed for successful uptake and adoption. Methods This was a stepped wedge, hybrid 3 implementation-effectiveness trial at 4 VA Medical Centers. Primary Care Mental Health Integration (PCMHI) providers attended a 3-hour live online BBTI training followed by a pre-implementation phase prior to receiving implementation support. During the 12-month implementation phase, strategies and support were provided by the hub-site and assisted by each site’s implementation champion. After 12-months, support was withdrawn. Data from the VA Corporate Data Warehouse were extracted across four phases (pre-training, pre-implementation, implementation, post-implementation) and compared within and between sites. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework informed outcomes; reach data is presented here from pre-training to pre-implementation and pre-implementation to implementation. Analyses were conducted using logistic regression with a fixed effect for study phase. Results Sites 2, 3, and 4 saw significant increases in the proportion of Veterans engaging in BBTI from post-training to pre-implementation (8.37% - 24.16%; ps 0.00001); site 1 did not have a pre-implementation phase. From pre-implementation to implementation, sites 1 and 3 saw significant increases in Veterans engaged in BBTI (7.32% - 22.3%; ps 0.0001), site 2 had a non-significant increase in BBTI (4.14%; p=0.21), and site 4 had a non-significant decrease in BBTI (-0.89%; p=0.82). All four sites also saw significant reductions in sleep medications prescribed in Primary Care (-0.60% - -1.43%; ps 0.0001) from pre-implementation to implementation. Conclusion BBTI training alone plus implementation support resulted in mixed findings across the four sites. However, BBTI in PCMHI increased over time across the study phases. BBTI plus implementation support also contributed to sleep medication reductions in Primary Care. Contextual barriers and facilitators also need to be evaluated to determine their impact on efforts to implement BBTI in VA PCMHI clinics. Support (if any) VA HSR&D I01HX003096