Qualitative Investigation of Primary Care Provider Perspectives on the Assessment and Treatment of Insomnia

Although common, insomnia is often undertreated and underrecognized in primary care settings. Few studies have examined primary care provider (PCP) perspectives to better understand the context of insomnia assessment and treatment. The purpose of the current study was to examine Veterans Affairs (VA) provider knowledge and practice regarding the assessment and treatment of insomnia by utilizing qualitative inquiry. We recruited PCPs at a VA healthcare facility located in the southeastern United States to engage in a qualitative descriptive study of their perspectives on the management of insomnia in the primary care setting. Participants completed a demographic form and semi-structured interviews. Interview data were analyzed using a rapid qualitative analysis approach. 12 PCPs participated in semi-structured interviews. Themes were knowledge gaps in appropriate assessment, treatment, and documentation practices. Providers tended to focus on the event that precipitated insomnia rather than factors that perpetuate it and relied heavily on sleep hygiene recommendations. Systemic barriers, such as time constraints, also impeded the highest quality of care. PCPs may benefit from additional training on factors that maintain insomnia and on evidence-based treatments for insomnia. There may also be an opportunity to develop tools such as shared decision-making aids to increase referrals to evidence-based treatments. Development of strategies to facilitate assessment and treatment of insomnia disorder in the context of busy, fast-paced primary care settings may be beneficial to veterans and civilians with sleep disorders.