A Self-Management Approach to Improving Continuous Positive Airway Pressure Adherence and Outcomes

Stepnowsky, Carl; Palau, Joe J.; Gifford, Allen L.; Ancoli‐Israel, Sonia

doi:10.1080/15402000701190622

Cited by 61 publications

(32 citation statements)

References 46 publications

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“…12,13,30 Such educational interventions directed at patients may have played a role in previous findings of better PAP adherence in OSA patients managed by specialists. 7,8 Specifically, in patients with OSA being treated by PAP therapy, Weaver and colleagues demonstrated that three major cognitive factors play a role in adherence to PAP therapy-the patient's perception of health risk associated with OSA, the patient's expectations of outcomes, and the patient's perceived ability to use the PAP device.…”

Section: Patient Educationmentioning

confidence: 98%

“…10 Specifically, patient education regarding their chronic disease condition can help improve risk perception and self-efficacy, and consequently serve to promote adherence to therapy and further improve health and well-being. [10][11][12][13] In our previous national survey, we demonstrated that patient education and risk perception mediated the observed better PAP adherence in patients cared for by accredited centers and certified physicians, but such cross-sectional measurements may be subject to recall bias and needed to be performed in a prospective manner. 7 Other important benchmarks in the management of patients with OSA such as timely delivery of care and patient satisfaction with care rendered by their physicians and centers are important patient-centric quality metrics that needed to be assessed.…”

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confidence: 99%

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A Multicenter Prospective Comparative Effectiveness Study of the Effect of Physician Certification and Center Accreditation on Patient-Centered Outcomes in Obstructive Sleep Apnea

Parthasarathy

Subramanian²,

Quan

2014

Journal of Clinical Sleep Medicine

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than those who did not receive such sleep specialist consultation. 8 Recently, a randomized controlled non-inferiority trial reported that treatment of OSA by primary care physicians was non-inferior to that of sleep specialists with regard to resolution Objectives: To study the effect of sleep center accreditation and Sleep Medicine board certifi cation of physicians on patient-centered outcomes in obstructive sleep apnea (OSA). Design: Prospective, multicenter, comparative effectiveness study. Setting: Four sleep centers Patients: 502 patients with OSA. Interventions: None. Measurements and Results: Patients at two accredited and two non-accredited centers underwent polysomnography at participating locations and completed validated questionnaires, with objective measurement of positive airway pressure (PAP) therapy adherence performed three months after therapy initiation. The proportion of patients (age 53 ± 13[SD] years; 26% women; and body mass index 33.6 ± 7.2 kg/m 2 ) who were adherent to PAP therapy by Medicare guidelines (> 70% of nights with ≥ 4 h use over a 30-day period) was greater in accredited (79%) than non-accredited sites (64%; p = 0.004). After adjustment for confounding variables, patients who received care from accredited centers (odds ratio [OR] 2.2, 95% confi dence interval [CI], 1.2-4.2; p = 0.016) and certifi ed physicians (OR 2.3, 95% CI, 1.3-4.0; p = 0.005) were more likely to be adherent to PAP therapy than those who received care from non-accredited centers and non-certifi ed physicians. Patient satisfaction was associated with greater education received from physician (OR 4.6; 95% CI 2.3-9.3); greater risk perception (OR 2.7; 95% CI 1.0-7.4); physician certifi cation (OR 2.1; 95% CI 1.1-4.2); and inversely related to delays in care (OR 0.5; 95% CI 0.3-0.9; p < 0.05). Such delays were inversely related to accreditation-certifi cation status (p < 0.0001). Conclusions:In patients with OSA, accreditation-certifi cation status of sleep centers and physicians was associated with better PAP adherence, better patient education, better patient satisfaction, and greater timeliness. S C I E N T I F I C I N V E S T I G A T I O N SH ealth care delivery in many disease conditions including obstructive sleep apnea (OSA) will be increasingly driven by quality metrics.1-3 One of the important quality metrics for OSA-adherence to positive airway pressure (PAP) therapyremains a huge problem, with adherence of greater than four hours of daily use ranging from 46% to 83%. 4,5 There is much emphasis on patient-centered care that focuses on outcomes relevant to patients such as improving patient satisfaction and enhancing the patient experience. 6 We have previously shown that in a cross-sectional national survey, patients with OSA cared for by American Academy of Sleep Medicine (AASM) accredited sleep centers or Sleep Medicine board-certifi ed physicians had lower positive airway pressure (PAP) discontinuation rates and reported greater patient satisfaction than patients cared for by non-accredited cent...

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Section: Patient Educationmentioning

confidence: 98%

mentioning

confidence: 99%

A Multicenter Prospective Comparative Effectiveness Study of the Effect of Physician Certification and Center Accreditation on Patient-Centered Outcomes in Obstructive Sleep Apnea

Parthasarathy

Subramanian²,

Quan

2014

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

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“…Although CPAP pressure settings commonly cannot be lowered for fear of loss of therapeutic effect, self-efficacy beliefs can be manipulated through targeted psychological interventions. 42,43 Our results suggest that these interventions may be most promising and suitable for those individuals at high risk for nonadherence due to high CPAP pressure settings.…”

Section: A Bbre V I Ati O Nsmentioning

confidence: 97%

“…Additional investigations should continue to examine the potential moderation and mediation of biomedical predictors of CPAP adherence by psychosocial factors. 34 Such a practice has proven fruitful in previous investigations, 40 and may highlight avenues to strengthen future interventions based on social cognitive theory, 42,43 or the newly proposed biopsychosocial model. 34 There are several limitations of the current investigation that need to be acknowledged.…”

Section: A Bbre V I Ati O Nsmentioning

confidence: 99%

Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence

Dzierzewski

Wallace

Wohlgemuth

2016

Journal of Clinical Sleep Medicine

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Study Objectives: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder associated with a myriad of sequelae. OSAHS is effectively treated with continuous positive airway pressure (CPAP) therapy. However, fewer than 50% of patients are compliant with their CPAP therapy prescriptions. The current study sought to explore an integrated, biopsychological approach to CPAP adherence among experienced CPAP users. Methods: We performed a retrospective, cross-sectional analysis of a cohort of veterans with a diagnosis of OSAHS (n = 191) who were prescribed CPAP therapy and returned for adherence download at the Miami VA Sleep Clinic. The relationships between biomedical characteristics (e.g., CPAP pressure, selfreported sleepiness, and change in sleep efficiency) and psychological factors (e.g., self-efficacy beliefs and psychological diagnoses) and objectively measured CPAP use were examined to determine whether psychological factors moderated the relationships between biomedical characteristics and CPAP adherence. Results: Hierarchical regression analyses predicting CPAP adherence (adjusting for time since CPAP prescription, age, education, prescribed CPAP pressure, daytime sleepiness, changes in sleep efficiency with CPAP, and psychiatric conditions) revealed the following: (1) CPAP self-efficacy and CPAP pressure were positively related to adherence, and (2) CPAP self-efficacy moderates the relationship between CPAP pressure and CPAP adherence. Conclusions: There was no relationship between CPAP pressure and adherence in individuals with low self-efficacy beliefs. However, for individuals with high self-efficacy beliefs, there was a significant positive relationship between CPAP pressure and adherence. Self-efficacy beliefs appear to be a prime target for focused interventions aimed at improving CPAP adherence among those individuals with higher pressure prescriptions. I NTRO DUCTI O NObstructive sleep apnea-hypopnea syndrome (OSAHS) is a very common clinical condition. Population-based estimates suggest that approximately 20% of adults, or one in five, meet the criteria for at least mild OSAHS, based on an apnea-hypopnea index ≥ 5.1 OSAHS can be effectively treated with continuous positive airway pressure (CPAP) therapy.2,3 However, adherence with treatment recommendations is relatively low. 4 We sought to examine previously described biomedical and psychological factors associated with CPAP adherence, as well as investigate whether psychological factors (i.e., self-efficacy beliefs) might modify the association of biomedical characteristics and CPAP adherence.Identification of predictors of CPAP adherence is critically important given the many unwanted negative consequences of untreated OSAHS, such as deficits across multiple cognitive domains, 5,6 when viewed in context of the extremely high nonadherence rates associated with CPAP therapy. Approximately 50% of patients prescribed CPAP are completely noncompliant with therapy recommendation at 1 y. 4 In addition, 15% to 30% of patients with...

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“…Previously, a system that could promote self-management by the patient-such as group education from a peer-support group or program-has been shown to have the potential to improve adherence to CPAP therapy. 28 However, this approach is limited by the logistics of the patient attending the group sessions and receiving personalized care. We proposed a telephonic system that allowed multiple communications between the patient and the peer buddy over a 3-month period in addition to two face-to-face meetings in the first week following CPAP initiation.…”

Section: Outcome Measuresmentioning

confidence: 99%

A Pilot Study Of CPAP Adherence Promotion By Peer Buddies With Sleep Apnea

Parthasarathy

Wendel

Haynes

et al. 2012

B108. Diagnostic and Therapeutic Approaches in Sleep Apnea

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BRIEF SUMMARYCurrent knowledge/Study Rationale: Poor adherence to the primary treatment of OSA-continuous positive airway pressure (CPAP) therapy-is common, and there is a paucity of easily accessible yet costeffective interventions that could promote CPAP adherence. Promoting adherence to therapy through peer-driven intervention is cost-effective and has met with modest success in other chronic conditions such as HIV, heart failure and diabetes mellitus, but whether such a peer-driven intervention can improve adherence to CPAP therapy is unknown. Study Impact: Our pilot study involved such a peer-driven intervention (experienced CPAP users called "peer-buddies") and suggests that such an intervention is feasible, results in high patient satisfaction, and promotes CPAP adherence. A larger, adequately powered study is needed, which, if successful, could potentially improve outcomes in a "patientcentered" and cost-effective manner.

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A Self-Management Approach to Improving Continuous Positive Airway Pressure Adherence and Outcomes

Cited by 61 publications

References 46 publications

A Multicenter Prospective Comparative Effectiveness Study of the Effect of Physician Certification and Center Accreditation on Patient-Centered Outcomes in Obstructive Sleep Apnea

A Multicenter Prospective Comparative Effectiveness Study of the Effect of Physician Certification and Center Accreditation on Patient-Centered Outcomes in Obstructive Sleep Apnea

Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence

A Pilot Study Of CPAP Adherence Promotion By Peer Buddies With Sleep Apnea

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