Telemedicine vs in-person delivery of cognitive behavioral treatment of insomnia: a mixed methods analysis
2017 Strategic Research Grant
PHILIP GEHRMAN, PHD
UNIVERSITY OF PENNSYLVANIA
Key Project Outcome
Telemedicine offers a means of providing healthcare with a reduced need for in-person appointments, potentially saving time and effort for patients. Telemedicine can also increase access to healthcare for patients who live in areas with a low amount of healthcare providers. A potential downside of telemedicine is that the loss of in-person contact could lead to poorer quality care.
This study sought to test the potential of telemedicine by comparing the efficacy of a standard non-medication treatment for insomnia when delivered in-person vs video telehealth. A third group received no treatment and served as a comparison group. The treatment tested was cognitive behavioral treatment for insomnia (CBT-I), which is delivered over the course of 6-8 weekly sessions. Sixty patients with insomnia were randomly assigned to in-person CBT-I, telehealth CBT-I, or the wait list control group. All three groups completed a series of questionnaires before treatment, shortly after treatment ended, and then again 3 months later. After the 3-month follow-up, subjects were also interviewed by phone in order to gather more information about their experience with treatment. The CBT-I providers were also interviewed about their experiences with in-person vs. telehealth treatment.
The study found that there was significant improvement in insomnia, as measured with the Insomnia Severity Index questionnaire, in both CBT-I groups but the improvement was no different in the telehealth group compared to the in-person group. The improvements were significantly better than in the waitlist group and were maintained over the 3-month period. There were also improvements in daily functioning and in feelings of anxiety and low mood. In the interviews, subjects expressed satisfaction with CBT-I regardless of how it was delivered. They appreciated the flexibility of receiving treatment by telehealth and the fact that they did not need to come into the office for appointments. CBT-I providers were positive in their experience with delivering care by telemedicine, although they preferred to be able to work with people in person. These results demonstrate that CBT-I can be delivered effectively by video telehealth and that this approach is acceptable to both patients and providers.