Active Duty Service Members, Primary Managers, and Administrators’ Perspectives on a Novel Sleep Telehealth Management Platform in the U.S. Military Healthcare System

Abstract

Introduction Sleep disorders are common in the military, and there is a gross shortage of sleep specialists in the military health system. The purposes of the present study were to (1) understand perceptions and expectations surrounding sleep telehealth approaches and (2) solicit feedback to optimize and refine a proposed novel sleep telehealth management platform. To accomplish these objectives, we investigated the perceptions, expectations, and preferences of active duty service members (ADSMs) with sleep disorders, primary care managers (PCMs), and administrative stakeholders regarding sleep telehealth management. Materials and Methods Using convenience sampling, we conducted five focus groups with 26 ADSMs and 11 individual interviews with PCMs from two military treatment facilities in the U.S National Capital Region and 11 individual interviews with administrative sleep stakeholders (9 military and 2 civilian). Results Active duty service members, PCMs, and administrative stakeholders provided insight regarding expectations for sleep telehealth as well as suggestions to optimize the novel sleep telehealth platform. In terms of outcomes, ADSMs expected sleep telehealth to improve sleep and convenience. Primary care managers expected improved sleep and other comorbidities, enhanced operational readiness, and reduced mortalities among their patients. Administrators expected increased access to care, optimized utilization of health services, realized cost savings, reduced accidents and errors, and improved military performance. In terms of the platform, for ADSMs, desired characteristics included delivery of timely clinical reports, improved patient–provider communication, and enhanced continuity of care. For PCMs and administrators,an ideal sleep telehealth solution will improve the diagnosis and triage of sleep patients, save PCM time, be easy to use, and integrate with the electronic health record system. Conclusion The proposed sleep telehealth platform appealed to nearly all participants as a significant force multiplier to enhance sleep disorder management in the military. Stakeholders offered valuable recommendations to optimize the platform to ensure its successful real-world implementation.

Virtual first: implementation of a novel sleep telehealth platform in the United States military

“…This study employed a sequential mixed-methods (qualitative [QUAL 1]-quantitative [QUANT]-qualitative [QUAL 2]) design driven by continuous engagement with stakeholders including patients, primary care managers (PCMs), and economic stakeholders. The initial qualitative phase included focus groups with patients with sleep problems as well as one-on-one key informant interviews with PCMs and economic stakeholders; research methods and results have been presented elsewhere (Abdelwadoud et al, 2021;Wickwire et al, 2022). This paper presents methods and results from the quantitative and final qualitative phases.…”

“…The sleep telehealth platform (WellTap R ) consists of an online web portal for patients and providers, a secure mobile app (Figure 1), and integrated wearable sensors using a commercial off the shelf sleep tracker. As described elsewhere (Abdelwadoud et al, 2021;Wickwire et al, 2022), the purposes of the sleep telehealth platform are to (1) help PCMs assess sleep complaints, (2) empower patients and PCMs to make evidence-based sleep treatment decisions, (3) deliver evidence-based behavioral sleep treatments via mobile devices, and (4) connect patients with sleep specialists in virtual or physical sleep centers. Figure 2 presents a schematic of the long-term vision for sleep telehealth in the military using this platform.…”

“…All information was derived from patient self-report or commercial wearable and subsequently processed within the WellTap application. Report content and format were tailored for their respective end users based on insights gained during the earlier qualitative phase of this study (Abdelwadoud et al, 2021;Wickwire et al, 2022). For patients, assessment results were received in-app.…”

“…Consistent with this approach, our group recently engaged, for the first time, key military stakeholders including patients, primary care manages (PCMs), and economic decision-makers in qualitative focus groups and key informant interviews designed to identify barriers and facilitators to sleep telehealth in the MHS. These stakeholders identified opportunities and provided recommendations to implement sleep telehealth via a novel platform designed to improve outcomes for all stakeholders (Abdelwadoud et al, 2021;Wickwire et al, 2022). This paper presents results of implementation of this novel sleep telehealth platform in two military treatment facilities (MTFs) in the National Capital Region (NCR).…”