Integrated diagnostic pathway for patients referred with suspected OSA: a model for collaboration across the primary–secondary care interface

Abstract

BackgroundObstructive sleep apnoea (OSA) presents a major healthcare challenge with current UK data suggesting that only 22% of individuals have been diagnosed and treated. Promoting awareness and improving access to diagnostics are fundamental in addressing these missing cases and the recognised complications associated with untreated OSA. Diagnosis usually occurs in secondary care with data from our trust revealing long wait times to undertake tests, reach a diagnosis and start treatment. This places a considerable time and emotional burden on the patient and a financial and logistical burden on the hospital.MethodsWe introduced an integrated community-based pathway for the diagnosis of OSA. This comprised a monthly clinic run from within a local general practice (GP) supported by a ‘virtual multidisciplinary team’ run by the hospital specialist team. Prospective collection of process, outcome and patient satisfaction data was compared with traditional hospital-based pathway data collected retrospectively.SettingA central London teaching hospital and GPs within a local commissioning neighbourhood.ResultsBetween January 2018 and February 2019, 70 were patients referred and managed along the community pathway. Compared with the hospital pathway, data demonstrated a significant reduction in the time taken: from referral to perform a sleep test (29 vs 181 days, p<0.0001), to make a diagnosis (40 vs 230 days, p<0.0001) and commence treatment (127 vs 267, p<0.0001). Patient satisfaction in the community pathway was higher across all domains (p<0.05), fewer hospital outpatient appointments were required and cost estimates suggested an overall saving of up to £290 could be achieved for each patient.ConclusionAn integrated community-based pathway results in more timely diagnosis of OSA within a local setting while maintaining specialist input from the hospital team. It is favoured by patients and can reduce unnecessary appointments in secondary care.

Knowledge and Attitude towards Obstructive Sleep Apnea among Primary Care Physicians in Northern Regions of Saudi Arabia: A Multicenter Study

“…The most likely factors for the dissimilarities in the results could be the study settings and the inclusion of participants. Regarding referral patterns, PCPs most commonly referred suspected and diagnosed OSA cases to an ENT specialist; Devaraj et al also found similar results [ 19 ].…”

“…The steps used to reach the diagnosis and initiation of treatment of OSA usually start in a PHC setting, followed by referral to secondary care, as OSA usually requires specialist input [ 19 ]. Devani et al, 2020, introduced a model for collaboration across primary and secondary care for patients with suspected OSA.…”

“…Devani et al, 2020, introduced a model for collaboration across primary and secondary care for patients with suspected OSA. This pathway allows patients to undergo a preliminary assessment and receive a sleep study device at a PHC setting while maintaining specialist input through a virtual multidisciplinary team [ 19 ].…”