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Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach : a small-scale qualitative interview study with GPs, nurses, and practice managers
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Collard, Victoria Elizabeth Janet, Moore, Corran, Nichols, Vivien P., Ellard, David R., Patel, Shilpa, Sandhu, Harbinder, Parsons, Helen, Sharma, U., Underwood, Martin, Madan, Jason and Tang, Nicole K. Y. (2021) Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach : a small-scale qualitative interview study with GPs, nurses, and practice managers. BMC Family Practice, 22 . 210. doi:10.1186/s12875-021-01552-3 ISSN 1471-2296.
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Official URL: https://doi.org/10.1186/s12875-021-01552-3
Abstract
Background:
Chronic pain and insomnia have a complex, bidirectional relationship – addressing sleep complaints alongside pain may be key to alleviating patient-reported distress and disability. Healthcare professionals have consistently reported wanting to offer psychologically informed chronic pain management at the primary care level. Research in secondary care has demonstrated good treatment efficacy of hybrid CBT for chronic pain and insomnia. However, primary care is typically the main point of treatment entry, hence may be better situated to offer treatments using a multidisciplinary approach. In this study, primary care service providers’ perception of feasibility for tackling pain-related insomnia in primary care was explored.
Methods:
The data corpus originates from a feasibility trial exploring hybrid CBT for chronic pain and insomnia delivered in primary care. This formed three in-depth group interviews with primary care staff (n=9) from different primary care centres from the same NHS locale. All interviews were conducted on-site using a semi-structured approach. Verbal data was recorded, transcribed verbatim and analysed using the thematic analysis process.
Results:
Eight themes were identified – 1) Discrepant conceptualisations of the chronic pain-insomnia relationship and clinical application , 2) Mismatch between patients’ needs and available treatment offerings, 3) Awareness of psychological complexities, 4) Identified treatment gap for pain-related insomnia, 5) Lack of funding and existing infrastructure for new service development, 6) General shortage of psychological services for complex health conditions, 7) Multidisciplinary team provision with pain specialist input, and 8) Accessibility through primary care. These mapped onto four domains - Current understanding and practice, Perceived facilitators, Perceived barriers, Ideal scenarios for a new treatment service – which reflected the focus of our investigation. Taken together these provide key context for understanding challenges faced by health care professionals in considering and developing a new clinical service.
Conclusions:
Primary care service providers from one locale advocate better, multidisciplinary treatment provision for chronic pain and insomnia. Findings suggest that situating this in primary care could be a feasible option, but this requires systemic support and specialist input as well as definitive trials for success.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RB Pathology R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Science > Psychology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Chronic pain, Insomnia -- Treatment, Insomniacs, Sleep -- Health apsects, Cognitive therapy -- Research, Primary care (Medicine), Pain -- Treatment | ||||||
| Journal or Publication Title: | BMC Family Practice | ||||||
| Publisher: | BioMed Central Ltd. | ||||||
| ISSN: | 1471-2296 | ||||||
| Official Date: | 20 October 2021 | ||||||
| Dates: |
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| Volume: | 22 | ||||||
| Article Number: | 210 | ||||||
| DOI: | 10.1186/s12875-021-01552-3 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 16 September 2021 | ||||||
| Date of first compliant Open Access: | 8 December 2021 | ||||||
| RIOXX Funder/Project Grant: |
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