Christina Eldridge

HLTH 634-B01
Final Program Plan

Sunset to Sunrise: Sleep your way to a healthier you!

A Pharmacist-Led Sleep Intervention Program
Christina Eldridge, PharmD, BCACP, NCPS
HLTH 634 B01
March 9, 2016

I.

Problem/Need statement:
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HLTH 634-B01
Final Program Plan
a. Research indicates that adults need seven to nine hours of sleep each
night, however one-third of Americans get fewer than seven hours per
night.1 Sleep disorders and a lack of sleep results in lost productivity,
contributes to vehicle accidents, and is associated with many health
problems.1,2 Sleeping less than 7 to 8 hours each night, irregular sleep,
or poor sleep quality are associated with heart disease, stroke,
diabetes, obesity, cancer, and high blood pressure. 1 Healthy People
2020 aims to increase the proportion of adults who get sufficient
sleep.3 This is defined as eight hours for adults aged 18 to 21 and 7
hours for adults over 21 years of age during a 24-hour period. 3 At
baseline in 2008, 69.6% of adults were getting sufficient sleep and the
target for 2020 is 70.8%.3
b. Pharmacists are readily available and easily accessible to patients and
can be used as a health educator in many settings. Working with
physicians, pharmacists can screen patients for sleep-related
disorders, refer patient for further evaluation and provide sleep health
information directly from the pharmacy.
II.

Goals and Objectives

a. Provide education about how much sleep is recommended for adults
b. Provide information about the risks associated with sleep deprivation
c. Follow up about sleep study referrals, recommended medication
changes and sleep hygiene tips
i. Objective 1: By the end of the pharmacist-led sleep intervention
program, 75% of Alaska Native/American Indian adults aged 18
years and older who receive care at the Alaska Native Medical
Center pharmacy will get at least 7 to 9 hours of sleep in a 24hour period, as measured by a sleep tracking record or device.
d. Screen patients who may be experiencing undiagnosed sleep disorders
e. Refer identified patients for further evaluation of sleep-related issues
f. Identify medication-related problems associated with sleep
disturbances
i. Objective 2: By the end of the pharmacist-led intervention
program, 80% of AN/AI adults aged 18 years and older who meet
the requirement for a sleep referral will be evaluated for a sleep
disorder, as measured by the electronic health record.

III.

Sponsoring agency/Contact person

a. Partnerships
I will partner with the Alaska Native Tribal Health Consortium (ANTHC)
and the Indian Health Service (IHS) to reach adults in my defined
population. The mission and vision of ANTHC is to provide the highest
quality of health services in partnership with the people and the Alaska
Tribal Health System so that Alaska Native people are the healthiest
people in the world.4 As a public health pharmacist within this
organization, I will identify those at risk who present to the pharmacy.
Patients often do not share sleep health with their primary care
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HLTH 634-B01
Final Program Plan

IV.

provider, however pharmacists are easily accessible and have the

opportunity to provide counseling about early detection and treatment
of sleep disorders while also encouraging healthy sleep habits. 5
Primary target audience
a. The targeted population for the pharmacist-led sleep intervention
program will be Alaska Native/American Indian (AN/AI) adults 18 years
of age and older who reside in the Anchorage Service Unit and receive
their medical care at the Alaska Native Medical Center. These
individuals will be identified by an electronic health record at the
Alaska Native Medical Center. Patients who are willing to share their
sleep habits, medications and social history will be targeted
specifically. The targeted population will include those who are willing
to accept sleep education and those who are ready to complete a sleep
study, if indicated.
i. Those identified as sleep deprived without the potential risk of a
sleep disorder will receive education by a pharmacist trained in
sleep health.
b. Primary target key strategies
i. Adults (over the age of 18 years) who present to the pharmacy
will be screened for sleep-related disorders
1. Multiple medications and disease states
a. Obesity
b. Diabetes
c. Cardiovascular disease
d. Depression
2. Medications used specifically to treat sleep disorders
3. Medications that may cause insomnia
ii. Willing to share sleep history and keep a sleep diary
iii. Follow-up
c. Participants will be encouraged to make getting an adequate amount
of sleep a priority.
i. Potential barriers may be occupational demands, caregiving of
elders and children, and seasonal changes (especially in
summer months).
1. Patients will be counseled about potential barriers to
getting an adequate amount of sleep including
occupation-related stressors, taking care of family
members (elders, children), and the financial pressures
requiring more than one place of employment. 2 Potential
addiction or dependence on drugs or alcohol will also be
addressed.
ii. Benefits are decreased risk of developing chronic health
conditions, increased productivity, and overall improved health
and well-being.
1. By making sleep health an important aspect of daily life,
AN/AI adults will be able to better care for family and be
more productive at work. Improvement of overall health,
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HLTH 634-B01
Final Program Plan

V.

including decreased risk of cardiovascular disease,

obesity, diabetes, and depression will also be
emphasized.2,3,6
iii. Reaching the intended audience will be best accomplished
through interpersonal channels.
1. Through the health communication, AN/AI adults will gain
knowledge about the importance of sleep health. Sleep
hygiene tips, sleep environment and information about
how much sleep is needed will be shared from the Centers
for Disease Control and Prevention (CDC).6 Data about
motor vehicle accidents and workplace injuries
contributed to sleep deprivation will also be shared as
part of the communication strategy. 2,6
2. Sleep hygiene and sleep health information will be
displayed on the television screens in the clinic waiting
areas. Information about sleep will also be provided to
patients at the pharmacy via brochures. Patients will
complete a sleep survey and those identified at an
increased risk of sleep disorders will be referred for
further diagnosis and treatment.
Secondary target audience
a. The secondary target audience will be those who are dependents and
minors of adult Alaska Native/American Indian participants. The goal is
that participants will be more educated about sleep health through this
intervention and share the information with their families/friends.
Children will grow up to understand the importance of getting at least
7 to 9 hours of sleep each night.
i. Children will learn by the example set forth by their elders
ii. Improved health for the next generation

VI.

Pretest strategy (trial of primary target message/channel)

a. Pre-testing educational materials will be done using positive emotional
appeals in while members of the intended audience will be shown all
the benefits of getting an adequate amount of sleep. Most people
enjoy getting rest, therefore the only urge that they may need to make
this a priority will be the information about the importance of adequate
sleep. It will be important to determine which concept has the greatest
appeal to the audience in order to make the desired behavioral change
and to find out what is not clear within the message.

VII.

Theoretical foundation (model or framework and how to use it in this

project)
a. The consumer information processing (CIP) model will be used as a
framework for the pharmacist-led sleep intervention program.
Providing education about sleep health is the main focus of the
intervention and will be the foundation for helping the intended
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HLTH 634-B01
Final Program Plan
population get the recommended amount of sleep. The CIP model
states that people will use health information if it is available, useful
and format-friendly. Incorporating simple tips for getting more sleep,
such as limiting screen time, creating a good sleeping environment or
eliminating medications that interfere with sleep are ways that health
educators can help people achieve their goals.
VIII.

Management chart
a. Timetable
i. The initial program will take place over a six-month period. At
the completion of the program, the results will be compiled and
shared with hospital administration.
b. Tasks for program staf
i. Initial screening
ii. Counseling (health education)
iii. Referral, if indicated
iv. Documentation
v. Follow-up
c. Responsible person
i. Lead Pharmacist/Manager
1. Oversee the program/develop messages
2. Train staf in sleep health and counseling techniques
3. Collect and analyze data
4. Conduct evaluation
5. Deliver results

IX.

Budget
a. Marketing Costs
i. Much of the advertising and promotion of the Sunset to Sunrise
Program will be covered by the Media Relations and Public
Relations department, including television advertisements,
newsletters and newspapers, since these are already
established, and therefore will not result in additional costs. The
only promotion/advertising costs will be for printed items which
are specific to the sleep health program.
1. Posters
a. 10 posters @ $10 each
2. Brochures
a. 5,000 brochures @ $1.12 each
3. Fred Meyer gift cards
a. $10/participant (estimated 1,000 participants or
~40/week over a 25-week period)
ii. Total Cost
1. Approximately $15,700
b. Justification
i. A large portion of the budget is associated with the incentive
program completion gift cards. This has been shown to be
efective in engaging this population, as demonstrated by a
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HLTH 634-B01
Final Program Plan
similar program to enroll patients into an online health
management tool, known as myANMC. Gift cards will only be
distributed to those who complete the program, including the
follow-up. The brochure cost was calculated on the higher end of
the estimated print cost, but could be as low as $0.60 each,
lowering the budget to an estimated $13,000.
ii. The brochures will be ordered in 1,000-count increments,
therefore, the budgeted amount of 5,000 may not be necessary
and therefore could lower costs. Much of the advertisement for
this program will reach participants at no additional cost when
they present to the pharmacy for prescription services.
Newspapers and publications that are already in place for this
population will not require any additional cost to the program.
The program will utilize the Media/Public Relations department
to create clinic television advertisements, resulting in no
additional program costs.
c. Personnel/Building Cost
i. The program will be stafed by pharmacists and pharmacy
technicians and will be overseen by the pharmacy manager. The
program will require some volunteer hours to compile and
analyze data, however much of the counseling and education
will be done during the pharmacy encounter as patients present
for refills or new prescriptions. The program staf consists of
current full-time paid positions in the pharmacy.
X.

Issues of concern/potential problems

a. Increased wait times for pharmacy services
i. Currently, the wait time for prescriptions to be filled is less than
15 minutes, however with the pharmacist-led sleep health
intervention program, patients will be at the pharmacy longer. In
order to avoid this impacting non-participants, one pharmacist
will be pulled from the schedule and will focus on program
participants only. This will require additional education at the
initial pharmacy encounter to verify that the patient is willing to
participate and that the program will require more time.
b. Space
i. There will also need to be a dedicated counseling room and
computer for the education and documentation to take place.
Space is limited in the pharmacy; this may require securing an
area outside of the pharmacy in times of high pharmacy volume.
This program will require the approval of hospital administration,
especially for the distribution of brochures to patient and the
posters that will be used to promote the program.

XI.

Evaluation strategies7
a. Evaluation questions
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Christina Eldridge
HLTH 634-B01
Final Program Plan
i. Does the participant know the amount of sleep he/she should be
getting each night?
ii. What are the unintentional consequences of sleep insufficiency?
iii. How many participants were referred for further evaluation for
sleep disorders and how many of those individuals actually
followed up with their provider?
iv. How many medication-related interventions by a pharmacist
were received and instituted?
v. What percentage of participants reported getting an adequate
amount of sleep after receiving sleep health education by a
pharmacist?
b. Data Collection
i. Data collection will be completed by a pharmacy staf member
and will come from the Alaska Native Medical Center electronic
health record (EHR), patient screening form and follow-up
telephone surveys and the data will be analyzed. Pharmacist
screening and counseling will be documented in the EHR and
patients who are referred for further evaluation as well as the
number of patients who actually receive diagnostic screening for
sleep disorders will be recorded. Pharmacist interventions
(diagnostic referrals and medication-related recommendations)
will be recorded/reviewed. The evaluation will determine how
many patients were screened, diagnosed and treated for
sleeping disorders, how many patients were identified for
inappropriate drug therapy for sleep-related disorders and the
efficacy of the sleep education received by adults as measured
by follow-up surveys. The goal by the end of the six-month
program is that 75% of participants will have made the intended
behavioral change and 80% of those who were referred for
further evaluation will have completed the referral.
ii. The evaluation data will be completed at the end of the 6-month
program and shared with hospital administrators as to whether
the pharmacist-led sleep clinic should continue or not. Areas for
improvement will be discussed and the program will be revised
accordingly. Pharmacists completing the program will need time
set aside from their work schedule to review the electronic
health record, compile data and complete telephone surveys.
c. Communication will be key for the sleep health intervention strategy.
i. Pharmacists are readily available and there is also a level of
trust between a pharmacist and a patient that will be helpful
when sharing important health-related information and getting
the person to receive this information.5 The social cognitive
theory (SCT) explains that behavior, cognitive and interpersonal
factors, and environmental events all operate as interacting
determinants of one another.8,9 While the environment shapes,
maintains, and constrains behavior, people are not passive in
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HLTH 634-B01
Final Program Plan
the process; they can create and change their environments. 9
Other core components of SCT that will be used in the
evaluation are enactive learning (the consequences of sleep
deprivation) and self-regulatory capability (motivated by the
internal standard to get at least 7 hours of sleep each night). 9

References
1. U.S. Department of Health and Human Services. Sleep Disorders &
Insufficient Sleep: Improving Health Through Research. NIH: National Heart,
Lung, and Blood Institute. http://www.nhlbi.nih.gov/news/spotlight/factsheet/sleep-disorders-insufficient-sleep-improving-health-through-research.
Accessed January 26, 2016.
2. U.S. Department of Health and Human Services. Who Is at Risk for Sleep
Deprivation and Deficiency? NIH: National Heart, Lung, and Blood Institute.
http://www.nhlbi.nih.gov/health/health-topics/topics/sdd/atrisk. Accessed
January 26, 2016.
3. U.S. Department of Health and Human Services. Sleep Health.
HealthyPeople.gov. http://www.healthypeople.gov/2020/topicsobjectives/topic/sleep-health. Accessed January 27, 2016.
4. Alaska Native Tribal Health Consortium. Who We Are. ANTHC.
http://anthc.org/who-we-are/vision/. Accessed January 27, 2016.
5. Fuller JM, Wong KK, Krass I, Grunstein R, Saini B. Sleep Disorders Screening,
Sleep Health Awareness, and Patient Follow-Up by Community Pharmacists in
Australia. Patient Educ Couns 2011; 83 (3): 325-35.
6. U.S. Department of Health and Human Services. Insufficient Sleep Among
Alaska Adults. CDC.
www.cdc.gov/sleep/pdf/states/Insufficient_Sleep_Fact_Sheet_2011_AK.pdf.
Accessed February 10, 2016.
7. Community Tool Box. Developing an Evaluation Plan. Community Tool Box.
http://ctb.ku.edu/en/table-of-contents/evaluate/evaluation/evaluationplan/main. Accessed February 24, 2016.
8. Parvanta C, Nelson DE, Parvanta SA, Harner RN. Essentials of Public Health
Communication. Burlington, MA: Jones & Bartlett Learning; 2011.
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HLTH 634-B01
Final Program Plan
9. U.S. Department of Health & Human Services. Making Health Communication
Programs Work. National Cancer Institute.
http://www.cancer.gov/publications/health-communication/pink-book.pdf.
Accessed February 24, 2016.