Effectiveness of intervention led by a community pharmacist for improving recognition of sleep apnea in primary care – a cohort study

Abstract

Summary Despite its high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. The aim of this study was to determine whether the involvement of a community pharmacist (CP) in the care pathway of a patient at risk of OSAS, through the implementation of a community pharmacist (CP) intervention, was effective, i.e. increased the use of diagnostic tests in this population. We compared a cohort of patients included in a research protocol (exposed to a CP intervention) with patients having the same characteristics taken from a general population database who did not receive the intervention (unexposed group). The aim of the CP intervention was to educate patients about the risk of untreated OSAS, encouraging them to consult their general practitioner, and urging the doctor to continue investigations. We included 782 patients at risk of OSAS, i.e. taking one or more anti‐hypertensive drugs, being overweight (body mass index >25) and snoring almost every night (88 in the exposed group and 694 in the unexposed group). After a 6‐month follow‐up, the number of patients who underwent an OSAS diagnostic test was significantly higher in the exposed group compared to the unexposed group (22.7 versus 11.4%, P = 0.003). Being exposed to the pharmacist intervention was associated with a higher chance of undergoing a diagnostic test for OSAS, adjusted odds ratio: 2.24 (1.25–4.01). In conclusion, these findings provide arguments for the implementation of a CP OSAS screening intervention in CP routine practice.

Cost-Effectiveness Analysis of the DiagnOSAS Screening Tool Compared With Polysomnography Diagnosis in Dutch Primary Care

“…In France, however, research has been conducted into the cost-effectiveness of a screening strategy in which the GP and community pharmacists collaborated closely. 10 Patients were screened by community pharmacists before visiting their GP. The collaboration was considered to be cost-effective by the researchers and indicated that there is potential in improving the process prior to the final diagnosis, as also corroborated by our results.…”

“…However, previous OSA cost-effectiveness studies assumed that patients have already received a diagnosis and have been screened. 7,10 Therefore, consequences of years of no treatment until final diagnosis were not taken into account in existing literature. The significance of this study comes with the scarcity of cost-effectiveness studies incorporating effects of OSA screening.…”

Community pharmacists' contribution to public health: assessing the global evidence base

“…Several published studies demonstrate the effectiveness of community pharmacy-based disease screening in promoting early detection and identification of patients at risk of stroke [50], diabetes [51], diabetes and hypertension [52], [53], sleep disorders [54], [55], cardiovascular risk [56], [57], [58], [59] and HIV [60]. A screening programme involving 30 pharmacies and 1,145 participants in Canada showed that an integrated stroke screening programme identified a high prevalence of individuals who could benefit from stroke-prevention therapies [50].…”

“…Further diagnosis from the referrals provided showed that community pharmacists could raise awareness and assist in initiating behavioural changes in those at risk of developing a sleep disorder [54]. A related study showed that the intervention was associated with higher odds of undergoing a diagnostic test for sleep disorders (adjusted OR: 2.24; 95% CI: 1.25-4.01) [61]. A qualitative study of participants' views of an AF screening service using an electrocardiogram (ECG) app in community pharmacies in Australia suggests that the service is acceptable, easy to use and feasible.…”

Obstructive Sleep Apnea: A Biomedical Perspective

“…The limited evidence has demonstrated the feasibility and effectiveness of CP services. 8,9,11,[14][15][16] It is possible that through the establishment of a screening program for a targeted population, CPs may be able to improve the identification of high risk of OSA among individuals. Interestingly, evidence from the experience of Australians has suggested that pharmacists have been pro-active in extending their roles for providing clinical services associated with OSA.…”