In a groundbreaking comprehensive review published in BMC Primary Care, researchers from Flinders University have unveiled critical insights into the integration of nurse-delivered care models for chronic sleep disorders within general practice settings. Despite robust evidence supporting the effectiveness of these models, their adoption in everyday clinical environments has remained surprisingly limited. This systematic review, led by sleep researcher and registered nurse Nicole Grivell, delves into the underlying barriers and facilitators shaping the translation of nurse-led sleep care from controlled research settings into routine practice.
The imperative for such an exploration arises from an escalating bottleneck in specialist sleep services worldwide. Conditions such as chronic insomnia and obstructive sleep apnea (OSA) are prevalent and often first identified during general practice consultations. Yet, prolonged wait times and restrictive access to cornerstone treatments like cognitive behavioral therapy for insomnia (CBTi) and continuous positive airway pressure (CPAP) therapy have created substantial gaps in care. Recognizing the untapped potential of general practice nurses, the Flinders team synthesized data from 85 diverse studies examining nurse-centered interventions across chronic disease management, with a particular lens on sleep disorders.
One of the profound revelations of this review is the nuanced understanding that effectiveness alone does not guarantee implementation success. Nurse-delivered care models, while clinically validated to improve sleep quality, daytime functioning, and overall health outcomes, are frequently stymied by system-level challenges. These challenges include inadequate funding mechanisms, workforce training deficits, and suboptimal service design that fails to account for the complex realities of patient lifestyles and clinic workflows. The researchers emphasize that these barriers contribute to a persistent underutilization despite proven benefits.
Central to the study’s findings is the critical role of co-design in service development. Integrating input not only from patients but also from general practice staff emerges as a pivotal factor for creating pragmatic, sustainable care models. This collaborative approach ensures that interventions are adaptable to the diverse capabilities, motivations, and daily routines of patients, as well as feasible within the operational constraints of busy GP clinics. The notion of co-design moves beyond token consultation, promoting genuine partnership to tailor interventions and delivery systems.
Co-author Professor Ching Li Chai-Coetzer highlights that nurses in general practice are uniquely positioned to bridge the gap between specialist sleep medicine and primary care. Their accessibility, ongoing relationships with patients, and holistic understanding of patient health enable them to deliver CBTi effectively and support adherence to CPAP therapies. This task-shifting not only has the potential to reduce specialist service demand but also enhances patient outcomes by providing timely, continuous care in more familiar and accessible settings.
The review also underscores the broader systemic impact, proposing that well-integrated nurse-delivered models could alleviate healthcare system pressures at large. By decentralizing specialized sleep treatment, these models offer scalable solutions to manage the burgeoning prevalence of chronic conditions that intersect substantially with sleep health, including cardiovascular disease, diabetes, and mental health disorders. Such models promise to optimize resource utilization, reduce clinical bottlenecks, and expedite patient access to high-quality care.
Further complicating implementation are variabilities in funding and policy support, which critically shape the sustainability of nurse-led programs. The review details how inconsistent reimbursement strategies and limited recognition of nurses’ expanded roles create financial and organizational disincentives. Overcoming these obstacles necessitates strategic advocacy and policy shifts aimed at embedding nurse-delivered sleep care firmly within general practice remuneration schemas.
The authors caution that failure to adequately design service models in partnership with end-users risks creating interventions that excel in controlled trials yet falter in complex real-world environments. This implementation gap represents a significant missed opportunity to capitalize on the clinical potential demonstrated in research. Robust implementation science frameworks and ongoing evaluation emerge as essential to bridging this divide and informing iterative improvements.
Taken together, the insights from this comprehensive review provide a compelling call to action for health system stakeholders. They advocate for deliberate, inclusive planning processes that bring together policymakers, clinicians, researchers, and the patients themselves. Such synergy is essential to foster the pragmatic innovation needed to transform primary care practice and deliver effective, equitable sleep health management.
In summary, while nurse-delivered sleep care models hold undeniable promise, their impact hinges on thoughtful, patient-centered design and supportive systemic infrastructure. As sleep disorders continue to impose significant individual and societal burdens, leveraging the unique capabilities of general practice nursing offers a transformative avenue to improve health outcomes while easing specialist service pressures. This review sets a new agenda for future research and health policy, emphasizing the indispensable role of stakeholder collaboration in overcoming entrenched barriers to sustainable, high-quality sleep care integration.
As the population ages and chronic disease burdens escalate, the importance of accessible, effective sleep health interventions cannot be overstated. This study from Flinders University stands at the forefront of redefining how primary care can rise to this challenge, positioning nurse-delivered models as vital components of a responsive, patient-centered health ecosystem.
Subject of Research: People
Article Title: Factors influencing the implementation of general practice nurse-delivered models of care for chronic conditions: a mixed-methods systematic review to inform models of care for chronic sleep disorders
News Publication Date: 14-Apr-2026
Web References:
https://doi.org/10.1186/s12875-025-03078-4
References:
Grivell N, Brown B, Fuller J, Chai-Coetzer CL, McEvoy RD, Hoon E. Factors influencing the implementation of general practice nurse-delivered models of care for chronic conditions: a mixed-methods systematic review to inform models of care for chronic sleep disorders. BMC Primary Care. 2026; DOI: 10.1186/s12875-025-03078-4.
Image Credits: Flinders University
Keywords: nurse-delivered care, sleep disorders, chronic insomnia, obstructive sleep apnea, cognitive behavioral therapy for insomnia, CPAP, general practice, implementation science, co-design, healthcare system, primary care, chronic disease management
