Effect of Telemedicine Education and Telemonitoring on Continuous Positive Airway Pressure Adherence The Tele-OSA Randomized Trial

被引：166
作者：
Hwang, Dennis [1 ]
Chang, Jeremiah W. [1 ]
Benjafield, Adam V. [2 ]
Crocker, Maureen E. [2 ]
Kelly, Colleen [3 ]
Becker, Kendra A. [1 ]
Kim, Joseph B. [1 ]
Woodrum, Rosa R. [1 ]
Liang, Joanne [1 ]
Derose, Stephen F. [1 ,4 ]
机构：
[1] Southern Calif Permanente Med Grp, Div Sleep Med, Fontana, CA USA
[2] ResMed Corp, ResMed Sci Ctr, Fontana, CA USA
[3] Kelly Stat Consulting, Fontana, CA USA
[4] Southern Calif Permanente Med Grp, Dept Res & Evaluat, Fontana, CA USA
来源：
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2018年 / 197卷 / 01期
关键词：
disease management; patient compliance; telehealth; OBSTRUCTIVE SLEEP-APNEA; BLOOD-PRESSURE; PATIENT EDUCATION; CPAP ADHERENCE; CLINICAL-TRIAL; IMPACT; METAANALYSIS; MANAGEMENT; PROGRAM; ADULTS;
D O I：
10.1164/rccm.201703-0582OC
中图分类号：
R4 [临床医学];
学科分类号：
1002 ; 100602 ;
摘要：
Rationale: Automated telemedicine interventions could potentially improve adherence to continuous positive airway pressure (CPAP) therapy. Objectives: Examining the effects of telemedicine-delivered obstructive sleep apnea (OSA) education and CPAP telemonitoring with automated patient feedback messaging on CPAP adherence. Methods: This four-arm, randomized, factorial design clinical trial enrolled 1,455 patients (51.0% women; age, 49.1 +/- 12.5 yr [mean +/- SD]) referred for suspected OSA. Nine hundred and fifty-six underwent home sleep apnea testing, and 556 were prescribed CPAP. Two telemedicine interventions were implemented: 1) web-based OSA education (Tel-Ed) and 2) CPAP telemonitoring with automated patient feedback (Tel-TM). Patients were randomized to 1) usual care, 2) Tel-Ed added, 3) Tel-TM added, or 4) Tel-Ed and Tel-TM added (Tel-both). Measurements and Main Results: The primary endpoint was 90-day CPAP usage. Secondary endpoints included attendance to OSA evaluation, and change in Epworth Sleepiness Scale score. CPAP average daily use at 90 days was 3.8 +/- 2.5, 4.0 +/- 2.4, 4.4 +/- 2.2, and 4.8 +/- 2.3 hours in usual care, Tel-Ed, Tel-TM, and Tel-both groups. Usage was significantly higher in the Tel-TM and Tel-both groups versus usual care (P = 0.0002 for both) but not for Tel-Ed (P=0.10). Medicare adherence rates were 53.5, 61.0, 65.6, and 73.2% in usual care, Tel-Ed, Tel-TM, and Tel-both groups (Tel-both vs. usual care, P = 0.001; Tel-TM vs. usual care, P = 0.003; Tel-Ed vs. usual care, P = 0.07), respectively. Telemedicine education improved clinic attendance compared with no telemedicine education (show rate, 68.5 vs. 62.7%; P = 0.02). Conclusions: The use of CPAP telemonitoring with automated feedback messaging improved 90-day adherence in patients with OSA. Telemedicine-based education did not significantly improve CPAP adherence but did increase clinic attendance for OSA evaluation.
引用
收藏
页码：117 / 126
页数：10
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