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BACKGROUND/RATIONALE:
A number of interventions to improve CPAP treatment adherence have been examined, with mixed results and limitations including lack of guiding theoretical model. The current project will use a patient-centered, collaborative care model, which focuses on providing the right treatment at the right time to chronic illness patients. The project will compare an individualized Self-Management (SM) intervention, a Telemonitored Care (TC) intervention, and Combined Care (SM+TC) relative to Usual Care control. Under Usual Care, there is a time lag, ranging in practice from days to weeks, between adherence data collection and data availability to care providers. Under Telemonitoring Care, adherence data are wirelessly transmitted to a remote server/database in 24-hour cycles, where they are then accessible to system-authorized care providers. Individualized Self-Management provides tailored education focused on increasing the knowledge and skills required by OSA patients to better use CPAP and manage their OSA.
OBJECTIVE(S):
The four primary aims of the research are (1) to compare the groups on level of CPAP adherence over the 3-month period of monitoring; (2) to compare the groups of proposed mediating variables from Social Cognitive Theory; (3) to compare the three groups on sleep apnea outcomes (e.g., severity of OSA symptoms and OSA-specific health-related quality of life); and (4) to analyze the costs of providing each intervention.
METHODS:
The study is designed as a randomized, controlled clinical trial of one control group (Usual Care) and three interventions-individualized Self-Management; Telemonitored Care; and Combined Care (Self-Management plus Telemonitored Care)-that takes advantage of the objective measurement of nightly adherence to the CPAP treatment regimen. Assessments will be made at baseline, post-intervention and 6-month follow-up.
FINDINGS/RESULTS:
NA
IMPACT:
Obstructive sleep apnea (OSA) is a major chronic condition affecting the quality of life of up to one-fifth of all Veterans. Because of disappointingly low adherence to the gold-standard treatment (continuous positive airway pressure therapy - CPAP), the Institute of Medicine has stated that new adherence strategies are needed that improve the quality of care, reduce social and economic costs, and help OSA patients live happier, healthier, and more productive lives through improved clinical management. The combination of a self-management approach along with emerging wireless technologies has strong potential to increase treatment adherence and improve outcomes.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems, Substance Abuse, Addictive Disorders
DRE:
Technology Development and Assessment, Quality of Care, Treatment
Keywords:
Sleep disorders, Telemedicine, Adherence
MeSH Terms:
none
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