LAUSR

Despite CBTI being the gold standard for insomnia treatment, numerous barriers need to be overcome in order for the field of sleep medicine to utilize CBTI as the front-line treatment. We investigated if a hybrid intervention combining groups, telehealth, and 1-on-1 visits would provide greater access to CBTI than the traditional model of in-person 1-on-1 sessions. Patients receiving CBTI in 2019 (in person, 1-on-1 visits, n=200) were compared to patients receiving CBTI in 2021 (CBTInitiate=hybrid telehealth/in-person, group/1-on-1 visits, n=299). In CBTInitiate, the first 1-on-1 follow-up session was replaced by a 60-minute telehealth group session that introduced sleep psychoeducation and stimulus control followed by 1-on-1 sessions. CBTInitiate (2021) was compared with traditional-CBTI (2019) on wait times (between consultation and initial follow up session; CBTInitiate and 1-on-1 follow-up) utilizing multivariate linear regression with age as a covariate. Treatment completer status (≥ 3 visits) was also compared between groups utilizing chi-square test and two-sample t-test. Dependent variables were log-transformed to meet normality assumptions. Age significantly differed between groups (Hybrid-CBTI=55.59; traditional-CBTI=51.87; t=2.763, p=.006) and was included as a covariate. CBTI type significantly predicted wait time to first follow-up (overall: R2=.25, F(2, 496)=.83.30, p<.001; β=-.50, p<.001). Back-transformation to estimated means show CBTInitiate patients had a shorter wait time to first follow-up (x̄=11.16 days) than traditional-CBTI (x̄=31.24 days). Age was not a significant predictor (β=-.03, p=.385). CBTI type also significantly predicted wait time from new evaluation to first 1-on-1 follow-up (overall: R2=.04, F(2,452)=8.99, p=<.001; β=.194, p<.001). Age was not a significant predictor (β=-.06, p=.229). However, CBTInitiate had a longer wait time (x̄=38.76 days) than traditional-CBTI (x̄=31.27days) for a 1-on-1 appointment. The CBTInitiate model addresses systemic, patient, and provider-level barriers to implementing CBTI as the gold-standard treatment for insomnia. The implementation of CBTInitiate significantly decreased wait times to begin CBTI and increased patients completing treatment compared to a traditional care model. Future areas for investigation include CBTInitiate’s impact on healthcare costs and insomnia treatment outcomes. None