Dr. David Rudilla
Improving the quality of life of patients undergoing continuous positive airway pressure (CPAP) treatment with sleep apnea diagnosis.
Obstructive sleep apnea (OSA) is a debilitating disorder that can be symptomatic or not and is accompanied by major neuro-cognitive and cardiovascular sequelae. Its prevalence rate is around 21-26% and increases every year with a significant impact on the health system. The standard of care is called continuous positive airway pressure (CPAP). Despite the effectiveness of the treatment, 30 to 60% of treated patients are not adherent. OSA complications might result in sudden death, stroke or heart arrhythmia leading to additional care cost for the healthcare system.
studies have demonstrated the effectiveness of personalized treatment to
improve adherence among CPAP-treated patients. Unfortunately, those studies
only focus on the medical device and not the patient itself.
PIMA has the ability to individualize the treatment according to specific patient’s needs.
Improving the adherence of CPAP treatment in order to enhance patients’ outcomes such as sleepiness, mood, activities and social relationships.
Firstly, certain socio-demographic characteristics are taken (age, level of education, use of technologies, accessibility). Then, a specific educational and training program called MEntA (Motivational Interview Adherence) is carried out. It allows the patient to better integrate the most elementary aspects for adherence: knowledge of OSA and habits, self-efficacy, and use.
To support this, a questionnaire with psychometric validation has been developed and allows to know the level of self-efficacy by the patient in order to monitor the therapy. This questionnaire works as a therapeutic interview that helps maintain the dialogue between the Air Liquide’s nurse and the patient.
Hence, PIMA starts from a patient segmentation in order to initiate the best care plan that adapts both to their personal characteristics and to the situation related to the therapy. Each care plan has different monitoring channels (face-to-face, home visit, Air Liquide assistance corner, virtual, …). It is worth noticing that during follow-up, a patient may require changes in care plans whether an improvement or decrease in adherence occurs. Outcomes of the patients such as degree of sleepiness, mood, activities, social relationships, and overall QoL are measured during each follow up point
flexibility and adaptation also allows benefits in treatment costs.
One randomized control trial (RCT) (with Clinical Research Ethics Committee approval) was carried out in three public hospitals in Spain: Hospital Joan XXIII (Tarragona), Hospital La Princesa (Madrid) and H. Central Asturias.
The total sample size of the RCT was 207 patients, PIMA allowed to significantly improve (2 hours per day) treatment adherence and quality of life compared to previous care pathway, becoming the standard treatment for all the patients in H. Universitario Central de Asturias.
PIMA works with physical and virtual visits adapted to individual patient needs with all the resources focused around the patient just like an IPU. This environment is composed of one psychologist specializing in communication skills and psychometric methodology, nurses and physiotherapists, hospital pulmonologists, and technical trained personnel able to deal with diverse incidents. The collaboration with the three hospitals and their teams has been fundamental since PIMA has been integrated into the standard treatment circuit.
The Spanish association of sleep apnea patients (ASENARCO) collaborated on the patient outcomes identification phase.