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Primary care provider evaluation and management of insomnia.

STUDY OBJECTIVES
To evaluate the type and extent of information collected from patients with insomnia during their first office encounter for insomnia and the prescribing therapies of primary care providers (PCPs) during this initial encounter.


METHODS
A retrospective chart review of randomly selected patients who had a PCP office visit at any clinic affiliated with a university medical system between March 1st, 2013 and March 1st, 2016. Demographic and clinical information was abstracted for analysis.


RESULTS
Our sample (n = 200) was primarily female (63.5%), white (69%), middle aged (44.6 ± 15.1) adults. Most (68.5%) encounter notes did not have significant information related to insomnia risk factors and symptoms (<50% of the note). When examining comorbidities, younger patients were more likely to have anxiety linked to insomnia (p-value = 0.025), whereas older patients were less likely to have any identified comorbidities associated with insomnia (p-value = 0.009). Only 5.0% of patients with insomnia were referred for cognitive behavioral therapy for insomnia (CBT-I), while 51.5% of patients were prescribed sleep medications. The younger cohort was statistically more likely to receive sleep hygiene or CBT-I as a treatment option in comparison to the older cohort (p-values = 0.01 and 0.04, respectively).


CONCLUSIONS
Progress notes from PCPs tend to have a paucity of information on insomnia symptoms and related comorbidities. Medications are often prescribed as the first-line treatment for insomnia. CBT-I remains underutilized despite robust evidence suggesting that CBT-I is a safe and effective treatment for insomnia.