SESSION TITLE: Cost and Quality Improvement
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 28, 2014 at 08:45 AM - 10:00 AM
PURPOSE: Most continuous positive airway pressure (CPAP) equipment available these days is equipped with smart cards to objectively and accurately monitor patient compliance. It is not known if this objective information is incorporated for patient care in the primary care setting. The purpose of this study was a) to assess awareness of smart card module amongst primary care providers (PCP) b) to assess accuracy of CPAP compliance assessment by PCPs.
METHODS: To assess awareness of smart card module for compliance assessment, we conducted a survey of internal medicine and family practice providers in a tertiary care teaching hospital. We obtained data regarding assessment of CPAP compliance by PCPs using retrospective review of electronic health records. This was compared with objective compliance data obtained from the smart card module for these patients. Compliance with CPAP was defined as use of CPAP > 70% or at least 4hrs of sleep time.
RESULTS: Out of 33 PCPs who completed the survey, all reported taking care of patients with obstructive sleep apnea (OSA). However only 23(70%) reported being aware about the smart card module for assessing compliance. We evaluated 109 patients who were prescribed CPAP therapy for OSA. PCPs deemed 56(51%) of these patients to be compliant with CPAP therapy. Of these, only 39 (70%) of the patients were truly compliant as assessed using the smart card data. At the same time, of the 53(47%) patients deemed non-compliant by PCPs, 21(39%) patients were found to be compliant when compared with objective data obtained from smart card module.
CONCLUSIONS: a) Although objective methods for compliance with CPAP are available, awareness amongst PCPs about these methods was low in this study. b) Compliance as assessed by PCPs was frequently inaccurate c) This study suggests a need for both physician and patient education for improving compliance with CPAP.
CLINICAL IMPLICATIONS: OSA is a disease with multi-organ system involvement. Compliance to CPAP is the key for management, in order to improve quality of life and to prevent serious debilitating diseases including stroke and coronary artery disease. We believe that our study will add a valuable piece of knowledge to health care providers taking care of above mentioned patient population. Ultimately it will have positive functional and financial impact on patients and our organization respectively.
DISCLOSURE: The following authors have nothing to disclose: Abhishek Mishra, Maninder Singh, Sukriti Kamboj, Sheela Prabhu, Dwight Stapleton
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