Encouraging General Practitioners to Refer Patients With Insomnia to a Digital Therapeutic (Sleepio): Feasibility...

Sleepio, a digital therapeutic offering digital cognitive behavioral therapy for insomnia, has been recommended by the National Institute for Health and Care Excellence in the United Kingdom as an alternative to offering sleep hygiene or sleeping pills. However, understanding of the referral behavior of general practitioners (GPs) regarding Sleepio is lacking.

The aim of this study was to investigate the feasibility of using an intervention targeting GPs in Scotland to increase referrals of patients with insomnia to Sleepio.

GPs working in primary care in Scotland were invited to join the study. GPs were recruited through the Primary Care Research Network in Scotland from June 10, 2024, to October 13, 2024. The behavior change wheel (BCW) was used to inform the design of the intervention. During the intervention, GPs reviewed an orientation on using Sleepio and received a visual reminder midway through the intervention. The primary outcome was the number of Sleepio referrals every 2 weeks over 2 months. The secondary outcome was the change in the GPs' reported confidence level that Sleepio will be successful in reducing patients' insomnia symptoms, and confidence in recommending Sleepio to patients.

Of the 23 GPs who joined the study, 16 completed all stages. Overall, 68.8% (11/16) of participants were females, and the mean age was 42 (SD 8) years. The total number of Sleepio referrals in 2 months was 96 for all 16 GPs. In the first 2 weeks of the intervention, the mean referral rate to Sleepio was 22.4% for all 16 GPs, but this rate increased to 45% by the end of week 8. A repeated measures analysis indicated there was no statistically significant difference in GPs' referral rates across 4 data points. GPs' reported confidence level in recommending Sleepio increased significantly (z=-3.436; P<.001), from a mean of 5.44 (SD 1.7; somewhat confident) to 8.13 (SD 2; very confident).

This study explored the feasibility and impact of an intervention aimed at supporting GPs to refer patients with insomnia to the digital therapeutic, Sleepio. Improvements were seen in GP-reported confidence levels at recommending Sleepio. A large-scale intervention and a longer study duration could provide useful information concerning how long the intervention effect on GPs' behavior toward Sleepio referrals might be maintained.