2004 OPEN FORUM Abstracts
Respiratory therapist-driven compliance program for initiation and delivery of positive airway pressure therapy
John
Basile, B.S., R.R.T., Ralph Pascualy M.D., Daniel Loube M.D.
Swedish Sleep Medicine Institute, Swedish Medical Center, Seattle,
Washington. Technical assistance by Susan Moon, Ph.D.
Background:
Compliance with PAP as a treatment for obstructive sleep apnea (OSA)
in prior studies was as low as 30 to 40%. Swedish Sleep Medicine
Institute developed a respiratory therapist-driven education and
intervention program to optimize compliance with positive airway
pressure (PAP) therapy for sleep apnea.
Methods:
The program was implemented in January of 2002 and included objective
monitoring of PAP compliance with a digital compliance meter. The
patient was seen initially within a few days of a PAP titration
study. The RT educated the patient about the importance of PAP
therapy, as well as in the use and care of equipment including
demonstration and practice with the equipment. The RT then contacted
the patient again within one week to assure acceptance of therapy.
Patient support was available 24 hours a day, 7 days a week. The same
RT provided subsequent care over time and compliance was monitored
serially over the next two years. Compliance was measured for
patients using CPAP, bi-level PAP, CPAP with the C-Flex feature and
automatic CPAP and compared. We defined adequate compliance as
greater than 4 hours of use of positive airway pressure for greater
than 70% of total time with the machine in use.
Results:
We demonstrated that an average compliance rate of 70% can be
obtained for PAP use with an intensive and consistent program of
RT-driven follow-up. However, compliance monitoring was available
only for those patients following up in the clinic. Of note were the
findings that compliance differed for the modes of positive airway
pressure used. Compliance was similar at approximately 70% for both
CPAP and auto-PAP but was approximately 20% lower for patients using
bi-level PAP.
Conclusions:
We have demonstrated that a respiratory therapy-driven PAP compliance
program results in a high compliance rate with emphasis being on
early and consistent follow-up. We also determined that compliance
with bi-level PAP is lower than that with CPAP. This may be a
consequence of the possibility that patients who end up using
bi-level PAP therapy are more severely ill or have more complicated
nocturnal breathing disorders than patients who remain on CPAP. When
available, RT driven compliance programs should be considered as a
primary option for assuring increased PAP compliance rates.