Positive airway pressure telehealth models and long-term therapy termination: a healthcare database analysis
Background Telemonitoring-guided interventions can improve short-term positive airway pressure (PAP) therapy adherence, but long-term effects are unknown. This study investigated long-term PAP therapy termination in patients with sleep apnoea managed with standard care, telemonitoring-guided proacti...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2024-02-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/10/1/00424-2023.full |
| _version_ | 1797278872212865024 |
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| author | Holger Woehrle Christoph Schoebel Joachim H. Ficker Andrea Graml Jürgen Schnepf Ingo Fietze Peter Young Michael Arzt |
| author_facet | Holger Woehrle Christoph Schoebel Joachim H. Ficker Andrea Graml Jürgen Schnepf Ingo Fietze Peter Young Michael Arzt |
| author_sort | Holger Woehrle |
| collection | DOAJ |
| description | Background
Telemonitoring-guided interventions can improve short-term positive airway pressure (PAP) therapy adherence, but long-term effects are unknown. This study investigated long-term PAP therapy termination in patients with sleep apnoea managed with standard care, telemonitoring-guided proactive care or telemonitoring-guided proactive care + patient engagement tool.
Methods
German healthcare provider data were analysed retrospectively. Individuals aged 18–100 years who started PAP from 2014 to 2019 and had device type/interface data were included. Time-to-termination periods were analysed using Kaplan–Meier plots and Cox proportional hazards regression, adjusted for age, sex, insurance type, and device and mask type.
Results
The per-protocol population (valid telemonitoring data) included 104 612 individuals (71% male; 95% aged >40 years). Mean follow-up was 3.3±2.0 years. The overall therapy termination rate was significantly lower in the telemonitoring-guided proactive care group versus standard care (20% versus 27%; p<0.001), and even lower in the telemonitoring-guided care + patient engagement tool group (11%; p<0.001 versus other treatment groups). Adjusted risk of therapy termination was lower versus standard care (hazard ratio 0.76, 95% confidence interval 0.74–0.78; and 0.41 (0.38–0.44) for telemonitoring-guided proactive care alone + patient engagement). Age <50 or >59 years and use of a nasal pillows or full-face mask were significant predictors of therapy termination; male sex, use of telemonitoring-guided proactive care (± patient engagement) and private insurance were significantly associated with lower therapy termination rates.
Conclusions
Use of telemonitoring-guided proactive care and a patient engagement tool was associated with lower rates of PAP therapy termination. |
| first_indexed | 2024-03-07T16:15:23Z |
| format | Article |
| id | doaj.art-e01d38b08c91413a8110f2d4a744ce78 |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-03-07T16:15:23Z |
| publishDate | 2024-02-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-e01d38b08c91413a8110f2d4a744ce782024-03-04T11:30:00ZengEuropean Respiratory SocietyERJ Open Research2312-05412024-02-0110110.1183/23120541.00424-202300424-2023Positive airway pressure telehealth models and long-term therapy termination: a healthcare database analysisHolger Woehrle0Christoph Schoebel1Joachim H. Ficker2Andrea Graml3Jürgen Schnepf4Ingo Fietze5Peter Young6Michael Arzt7 Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany Department of Sleep Medicine, University Duisburg-Essen, Essen, Germany Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuernberg and Paracelsus Medical University, Nuernberg, Germany ResMed Science Center, ResMed Germany, Martinsried, Germany ResMed Science Center, ResMed Germany, Martinsried, Germany Centre for Sleep Medicine, CCM-CC11, Charité-Universitätsmedizin Berlin, Berlin, Germany Department for Neurology, Medical Park, Bad Feilnbach, Germany Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany Background Telemonitoring-guided interventions can improve short-term positive airway pressure (PAP) therapy adherence, but long-term effects are unknown. This study investigated long-term PAP therapy termination in patients with sleep apnoea managed with standard care, telemonitoring-guided proactive care or telemonitoring-guided proactive care + patient engagement tool. Methods German healthcare provider data were analysed retrospectively. Individuals aged 18–100 years who started PAP from 2014 to 2019 and had device type/interface data were included. Time-to-termination periods were analysed using Kaplan–Meier plots and Cox proportional hazards regression, adjusted for age, sex, insurance type, and device and mask type. Results The per-protocol population (valid telemonitoring data) included 104 612 individuals (71% male; 95% aged >40 years). Mean follow-up was 3.3±2.0 years. The overall therapy termination rate was significantly lower in the telemonitoring-guided proactive care group versus standard care (20% versus 27%; p<0.001), and even lower in the telemonitoring-guided care + patient engagement tool group (11%; p<0.001 versus other treatment groups). Adjusted risk of therapy termination was lower versus standard care (hazard ratio 0.76, 95% confidence interval 0.74–0.78; and 0.41 (0.38–0.44) for telemonitoring-guided proactive care alone + patient engagement). Age <50 or >59 years and use of a nasal pillows or full-face mask were significant predictors of therapy termination; male sex, use of telemonitoring-guided proactive care (± patient engagement) and private insurance were significantly associated with lower therapy termination rates. Conclusions Use of telemonitoring-guided proactive care and a patient engagement tool was associated with lower rates of PAP therapy termination.http://openres.ersjournals.com/content/10/1/00424-2023.full |
| spellingShingle | Holger Woehrle Christoph Schoebel Joachim H. Ficker Andrea Graml Jürgen Schnepf Ingo Fietze Peter Young Michael Arzt Positive airway pressure telehealth models and long-term therapy termination: a healthcare database analysis ERJ Open Research |
| title | Positive airway pressure telehealth models and long-term therapy termination: a healthcare database analysis |
| title_full | Positive airway pressure telehealth models and long-term therapy termination: a healthcare database analysis |
| title_fullStr | Positive airway pressure telehealth models and long-term therapy termination: a healthcare database analysis |
| title_full_unstemmed | Positive airway pressure telehealth models and long-term therapy termination: a healthcare database analysis |
| title_short | Positive airway pressure telehealth models and long-term therapy termination: a healthcare database analysis |
| title_sort | positive airway pressure telehealth models and long term therapy termination a healthcare database analysis |
| url | http://openres.ersjournals.com/content/10/1/00424-2023.full |
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