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A3632 - Engaging Stakeholders to Improve Care: Barriers and Facilitators in Primary Care Delivery for Sleep Disordered Breathing
Author Block: S. R. Pendharkar1, K. G. Blades2, J. E. Kelly2, W. H. Tsai3, A. Vaidya4, D. C. Lien5, B. Hemmelgarn1, F. Clement6, J. Woiceshyn7, K. A. McBrien8; 1Medicine/Community Health Sciences, University of Calgary, Calgary, AB, Canada, 2Ward of the 21st Century, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada, 3Rockyview General Hospital, Calgary, AB, Canada, 4South Calgary Primary Care Network, Calgary, AB, Canada, 5University of Alberta, Edmonton, AB, Canada, 6Community Health Sciences, University of Calgary, Calgary, AB, Canada, 7Haskayne School of Business, University of Calgary, Calgary, AB, Canada, 8Family Medicine/Community Health Sciences, University of Calgary, Calgary, AB, Canada.
RATIONALE: Sleep Disordered Breathing (SDB) affects over 25% of the population and has significant individual and public health consequences. Recent randomized trials have suggested that management of milder forms of SDB by primary care providers (physicians and nurses; PCPs) is efficacious and cost-effective. Furthermore, management of SDB in the medical home is likely to be preferred by patients. However, the integration of PCPs and specialists in a comprehensive service delivery model for patients with different severities of SDB remains a major challenge. A critical initial step in designing such a model is to identify the barriers and facilitators to optimal, patient-centred SDB care, from the perspective of PCPs, sleep specialists and patients.
METHODS: The study setting is the province of Alberta, Canada, in which diagnosis and treatment of SDB is initiated by PCPs and provided through a mix of specialized sleep centres and private respiratory homecare companies, using pathways that include home sleep apnea testing and polysomnography. We conducted a series of stakeholder engagement activities to understand the current state of SDB care in Alberta. These activities included: a survey of PCPs in Alberta, from which we received over 120 responses; semi-structured focus groups and interviews of 28 patients from rural and urban communities in Alberta; and two full-day workshops in which we brought together 36 healthcare providers (PCPs, sleep specialists, and respiratory therapists) from around Alberta. Focus groups, interviews and workshops were recorded and transcribed verbatim before thematic analysis was done.
RESULTS: We identified five key barriers to providing optimal SDB care: gaps in PCP knowledge leading to a lack of confidence in managing SDB; long wait times for assessment by specialists in the public healthcare system; highly variable care delivered by private respiratory homecare companies; fragmented care due to poor communication among patients and providers and unclear role definitions for providers; and costs of testing and treatment. Patients and providers also proposed potential strategies to mitigate these barriers, including the establishment of best practice guidelines, regulatory standards and clinical pathways for SDB care.
CONCLUSIONS: Patients and healthcare providers identified significant barriers to optimal SDB care in Alberta. A novel service delivery model for SDB must mitigate these barriers in order to provide high-quality, patient-centred care.