The Science Journal of the American Association for Respiratory Care

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.

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