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Real World Experiences and Clinical Outcomes of Patients on Continuous Positive Airway Pressure or Chronic Noninvasive Ventilation
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A1503 - Real World Experiences and Clinical Outcomes of Patients on Continuous Positive Airway Pressure or Chronic Noninvasive Ventilation
Author Block: E. Gan1, C. Goh2, M. Lau2, S. Goh2, A. Yii3; 1General Medicine, Changi General Hospital, Singapore, Singapore, 2Medical Social Services, Changi General Hospital, Singapore, Singapore, 3Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore.
Rationale: The clinical efficacy of continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA), and noninvasive ventilation (NIV) for chronic hypercapnic respiratory failure are well-established. However, data are scarce about real-world patient experiences and clinical outcomes when using these respiratory devices. Such data are important to identify gaps in service provision and guide subsequent improvement. Our aim was to evaluate patient usage patterns and experiences of long-term CPAP or NIV, and assess the impact on unscheduled or emergency health care utilization.
Methods: In Jan-Feb 2017, a phone-based survey was conducted among patients who had received social financial assistance for CPAP or NIV between Dec 2013 and Dec 2016 at Changi General Hospital, Singapore. A semi-structured interview questionnaire was conducted. Medical records were reviewed to assess emergency visits or hospital admissions.
Results: A total of 81 users were identified, mean age 56 +/- 15 yrs, and 53% were male. 62 (76%) responded to the survey, 11 (14%) had died at the time of the survey and 8 (10%) were uncontactable. The indication was OSA in patients using CPAP, and among the 22 patients on chronic NIV the indications were OSA-obesity hypoventilation syndrome (45.4%), chronic obstructive pulmonary disease (40.9%), interstitial lung disease(9%) and miscellaneous. Among respondents, 69% reported active usage with a mean of 6.35 h/day, whereas the remaining had ceased usage at the time of the survey. Among those who reported active usage, 75% reported either feeling “better” or “much better” in their overall condition after using CPAP or NIV, whereas the remaining reported no change in condition. Comments from active users included improvement in energy levels, improved sleep quality, reduced respiratory symptoms, fewer respiratory exacerbations, improved functional status, and requiring the machine to survive. Among patients who ceased using the equipment, reasons identified included mask or device issues, discomfort associated with use, and not knowing how to operate the device. All-cause unscheduled admissions reduced from 1.26 to 0.73/person-year after initiation of CPAP/NIV (Wilcoxon Signed Rank test, p=0.007).
Conclusion: Most users of CPAP or NIV reported positive experiences with use of these devices, and demonstrated reduced unscheduled/urgent admissions post commencement of CPAP/NIV. Negative user experiences were associated with cessation of use and related to unaddressed technical issues, discomfort and poor knowledge, identifying areas of potential gaps in care for this group of patients.
Author Block: E. Gan1, C. Goh2, M. Lau2, S. Goh2, A. Yii3; 1General Medicine, Changi General Hospital, Singapore, Singapore, 2Medical Social Services, Changi General Hospital, Singapore, Singapore, 3Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore.
Rationale: The clinical efficacy of continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA), and noninvasive ventilation (NIV) for chronic hypercapnic respiratory failure are well-established. However, data are scarce about real-world patient experiences and clinical outcomes when using these respiratory devices. Such data are important to identify gaps in service provision and guide subsequent improvement. Our aim was to evaluate patient usage patterns and experiences of long-term CPAP or NIV, and assess the impact on unscheduled or emergency health care utilization.
Methods: In Jan-Feb 2017, a phone-based survey was conducted among patients who had received social financial assistance for CPAP or NIV between Dec 2013 and Dec 2016 at Changi General Hospital, Singapore. A semi-structured interview questionnaire was conducted. Medical records were reviewed to assess emergency visits or hospital admissions.
Results: A total of 81 users were identified, mean age 56 +/- 15 yrs, and 53% were male. 62 (76%) responded to the survey, 11 (14%) had died at the time of the survey and 8 (10%) were uncontactable. The indication was OSA in patients using CPAP, and among the 22 patients on chronic NIV the indications were OSA-obesity hypoventilation syndrome (45.4%), chronic obstructive pulmonary disease (40.9%), interstitial lung disease(9%) and miscellaneous. Among respondents, 69% reported active usage with a mean of 6.35 h/day, whereas the remaining had ceased usage at the time of the survey. Among those who reported active usage, 75% reported either feeling “better” or “much better” in their overall condition after using CPAP or NIV, whereas the remaining reported no change in condition. Comments from active users included improvement in energy levels, improved sleep quality, reduced respiratory symptoms, fewer respiratory exacerbations, improved functional status, and requiring the machine to survive. Among patients who ceased using the equipment, reasons identified included mask or device issues, discomfort associated with use, and not knowing how to operate the device. All-cause unscheduled admissions reduced from 1.26 to 0.73/person-year after initiation of CPAP/NIV (Wilcoxon Signed Rank test, p=0.007).
Conclusion: Most users of CPAP or NIV reported positive experiences with use of these devices, and demonstrated reduced unscheduled/urgent admissions post commencement of CPAP/NIV. Negative user experiences were associated with cessation of use and related to unaddressed technical issues, discomfort and poor knowledge, identifying areas of potential gaps in care for this group of patients.
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