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Somnologie (Berl). 2017;21(2):121-127. doi: 10.1007/s11818-016-0098-9. Epub 2017 Jan 23.

Telemedicine-based proactive patient management during positive airway pressure therapy: Impact on therapy termination rate.

Author information

1
Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm, Olgastr. 83, 89073 Ulm, Germany.
2
ResMed Science Center, ResMed Germany, Martinsried, Germany.
3
Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Nuremberg, Germany.
4
Paracelsus Medical University, Nuremberg, Germany.
5
Centrum für Herz-Kreislauf- und Gefäßmedizin, Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
6
Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Universitätsklinikum Münster, Münster, Germany.
7
Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
8
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany.

Abstract

in English, German

BACKGROUND:

Adherence to positive airway pressure (PAP) therapy is essential for the benefits of therapy to be realised. Telemedicine-based strategies provide a new option for enhanced monitoring and intervention to promote adherence during PAP. This study investigated the impact of telemedicine-based proactive patient management on PAP therapy termination rates versus standard care.

METHODS:

Observational data were obtained from ResMed Germany Healthcare, a German homecare provider. Patients were undergoing routine homecare using either a standard or proactive management strategy. The proactive strategy used data from AirView™, a cloud-based remote monitoring system, to prompt patient contact and information sharing/education. Patients receiving their first PAP therapy were included and analysed in matched pairs.

RESULTS:

In all, 3401 patients were included in each group. In the first year of PAP therapy, overall therapy termination rate was significantly lower (5.4% vs 11.0%; p < 0.001) and time to therapy termination was significantly longer (348 ± 58 vs 337 ± 76 days; p < 0.05) in the proactive versus standard care group. Cox proportional hazard analysis revealed a significantly reduced risk of PAP termination in the proactive versus the standard care group (hazard ratio 0.48, 95% confidence interval 0.4-0.57). Findings were consistent in subanalyses according to gender, type of device and insurance status, and in patients aged ≥40 years. However, in the subgroup of patients aged younger than 40 years, the risk of PAP termination was similar in the proactive and standard groups.

CONCLUSION:

A telemedicine-based proactive management strategy compared with standard care of PAP patients was associated with a lower long-term therapy termination rate.

KEYWORDS:

Health behavior; Monitoring, ambulatory; Obstructive sleep apnea; Patient adherence; Patient compliance

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