1. HFHT Health Plan Academic Detailing Program Chronic Adult Insomnia
Margaret Jin, BScPHM, PharmD, MSc, CDE

2. Health Planning Steps Background on academic detailing Discovery
Project Proposal
Monitoring Dashboard
Evaluation

3. Academic Detailing
Pharmacists provided one-on-one or small group evidence-based material to clinicians
HFHT experience
Topics since January 2008
Smoking Cessation
Hypertension
Chronic Pain Management
Depression
New Oral Anticoagulants & Perioperative Management
Marijuana

4. Discovery Next topic: Chronic Adult Insomnia
What issues/problems do we want to improve?
Improve the management of chronic insomnia using Cognitive Behavioural Therapy – Insomnia (CBT-I)
Improve appropriate prescribing for the management of chronic insomnia
Minimize long-term use of pharmacotherapy, such as benzodiazepines or Z-drug
Optimize the resources we have at the HFHT to provide CBT-I services

5. What has the HFHT tried before?
Cognitive Behaviour Therapy Insomnia (CBT-I) 10-week group HFHT office a few years ago
Poor uptake, not many physicians/pharmacists aware of program
10 weeks – too long to commit
At the practice level (currently)
Some individual CBT-I referrals to mental health counselors (MHC)
Some pharmacists (PHM) assist with benzodiazepine tapering
?Not many referrals to each for various reasons (MHC=long waiting list, PHM=DM/smoking)

6. Project Proposal
Pharmacists to provide an academic detailing service to clinicians
Some key messages (see draft handout)
Cognitive Behaviour Therapy for Insomnia (CBT-I) is 1st line therapy
Refer to CBT-I program offered through HFHT
If using drug therapy, consider for short term use only (<5 weeks)
If patient is taking benzodiazepine or Z-drugs for a prolonged period of time, consider tapering and/or discontinue
Refer to pharmacist for assistance

7. Project Proposal
Cognitive Behaviour Therapy for Insomnia (CBT-I) to be offered in various ways:
Revise 10-week version into 5-weeks
Individual referrals to mental health counselors
Shared Medical Appointments
Group visits on CBT-I at the HFHT office?
Websites

8. Resources Required Mental Health Counselors Pharmacists
IT – develop and incorporate validated tools into EMRs
CBT-I workshop – opportunity for pharmacists and other allied health to attend
Hincks-Dellcrest Centre - $2500+
McMaster – TBD?

9. Timelines July/August 2016
Draft CBT-I 10-week version into 5-weeks (Tricia/Catherine)
Draft and finalize the evidence-based materials (MJ)
Prepare education materials for pharmacists (MJ)

10. Timelines September/October 2016
Guest Speaker? Dr. Gottschalk? To physicians and HFHT allied health on chronic insomnia management
Pharmacists, mental health counselors, others? to attend CBT-I 1-2 day workshop?
Train pharmacists on the evidence
All forms to be in EMR (tools, patient handouts, sleep diaries, etc)
Select practices to discuss Plan-Do-Study-Act for Shared Medical Appointments with or without facilitators

11. Timelines
October 2016
Pharmacists to detail the prescribers on the evidence-based materials
Initiate shared medical appointments at select practices (require pharmacist, physician and mental health counselor to work on the same day)

12. Monitoring Dashboard Plan-Do-Study-Act Pharmacist meet every 2 weeks
Data collection (pre/post?)
Individual CBT-I referrals to Mental Health Counselor
Individual Pharmacist referrals to Benzodiazepine or Z-drug tapering/deprescribing
# of patients attending Shared Medical Appointments
# of patients going to group session at HFHT (if offered)

13. Evaluation
Evaluation forms provided to each clinician after each academic detailing session
Patient evaluation of the group session

14. Next Steps
Working Group – meet in July (Antony, Catherine, Laurel, Margaret, Tricia)
Funding for the CBT-I workshop?
Guest Speaker? Dr. Gottschalk?
Reviewers for the evidence-based materials?
Academic detailing program to physicians who do not have a pharmacist?
CBT-I group sessions at the HFHT office?

15. Questions?