Authors: (including presenting author): :
Tang WT, Tse PY, Ip KL, Yu HY, Chow MC, Lam YF, Ng ML, Miu PL
Affiliation: :
Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
Obstructive sleep apnea
Keyword 2: :
Continuous positive airway pressure
Keyword 5: :
Nurse Clinic
Introduction: :
Obstructive sleep apnea (OSA) poses significant health risks, with continuous positive airway pressure (CPAP) being the gold standard treatment. CPAP titration is essential for determining optimal pressure before therapy initiation. Traditionally, physician follow-ups to discuss titration results and treatment plans with patients often involves lengthy wait times, delaying therapy initiation and increasing health risks. Additionally, initial CPAP experiences significantly impact long-term adherence. In response, PYNEH implemented a pilot nurse-led clinic care service to expedite CPAP initiation and enhance patients’ self-care.
Objectives: :
To evaluate the impact of nurse-led clinic (NLC) care compared to physician-led clinic (PLC) care for CPAP initiation in:
•Reducing waiting time for CPAP initiation
•Improving CPAP adherence
•Treatment efficacy
•Managing side effects
Methodology: :
Between January and April 2024, newly diagnosed OSA patients after titration were assigned to either NLC or PLC for CPAP initiation. Following titration, specialists reviewed CPAP titration report and formulated treatment plans before patients' visits to either clinic. During nurse clinic visit, nurses explained the endorsed titration results and discussed the specialists’ CPAP treatment plan with patient. Comprehensive education on OSA and CPAP was provided, covering acclimation strategies, mask fitting, side effect management, lifestyle modification and self-monitoring of symptoms. Educational materials and online videos were also provided to enhance patient self-care confidence.
A retrospective analysis compared waiting times for CPAP initiation, and patient outcome data from follow-up visits (3 to 6 months after CPAP initiation) were retrieved from CMS.
Result & Outcome: :
78 patients were included (NLC:36, PLC:42). Baseline characteristics (AHI [apnea-hypopnea index], gender, BMI, and excessive sleepiness scale) showed no significant differences, except for age (NLC: 61.72; PLC: 56.69; p=0.011).
•NLC care reduced waiting time for CPAP initiation by 5.92 weeks (p=0.003) and reduced 36 physician follow-ups
•Comparable CPAP uptake rates (NLC:69.4%; PLC:64.3%; p=0.793)
•Comparable good CPAP adherence rates (≥70% of days with ≥4 hours usage) (NLC:48%; PLC:42.9%; p=0.707)
•Satisfactory treatment efficacy for both groups with residual AHI < 5/hrs (p=0.27)
•No significant differences in patient-reported side effect (leakage, pressure intolerance, aerophagia, dryness) between groups (p>0.05) Conclusion
Nurse-led clinic care for CPAP initiation was non-inferior to physician-led clinic in terms of quality of care, alleviating pressure on physician clinics and enhancing healthcare efficiency.
