Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For patients with insomnia, how do commonly used medications compare for effectiveness and harms, including addictive potential.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

1)insomnia medications, including but not limited to, benzodiazepines, antidepressants (e.g. trazodone), ambien 2) nonpharmacologic therapies

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

adults, both genders, with chronic insomnia

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

yes, those with comorbid mental health or general conditions that often experience insomnia. For example, depression and other mental health disorders, dementia

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

quality of life, sleep quality, fatigue

Describe any health-related risks, side effects, or harms that you are concerned about.

headaches, nightmares, changes in thoughts or cognition, addiction

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Dementia, including Alzheimer's disease
• Depression and other mental health disorders

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

There is a variation and uncertainty surrounding which of these medications are best to use

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

A clinical practice dilemma that we commonly encounter in primary care

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

It's uncertain which of these medications are most effective. In addition, it's unclear when medications should be used as opposed to nonpharmacologic treatments

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

the answers will guide the approach to treating insomnia and hopefully be used by some group to develop practice guidelines

Describe the timeframe in which an answer to your question is needed.

uncertain

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

the answers will guide the approach to treating insomnia and hopefully be used by some group to develop practice guidelines

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

colleagues