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The long patient´s journey for OSA diagnosis and treatment in a public university hospital in Brazil
OSA is diagnosed by fullnight polysomnography, gold standard treatment needing CPAP titration. At Brazilian public health System SUS, patients are referred from the basic health unit to the sleep unit, which have long waiting lists for exams; Delay of distribution of CPAPs depending of the waiting lists of the cities.
To evaluate the tims intervals for the diagnosis and treatmente flow in the public sleep servisse of a university in Brazil.
Adults parient’s charts who realized diagnosis PSG in the sleep lab at HCFMB Botucatu-UNESP in 2017 were analyzed, excluding neuromuscular disease patients and Split night exams. Demographic profile of the patients was obtained at the patient’s drop-off at each step, and how many patients received a CPAP machine at time of analysis.
Out 347 patients who realized OS, 200 had indication for CPAP, 103 (51%) concluded CPAP titration, being 78% obse, 71% hypertension, 44% DM, 15% COPD. Waiting time was T1: 197 days, T2: 208 days, T3: 98 days. Only 35% started CPAP tratment, the remaining 65% still waiting for the machine by December 2020. Out of the 347, 98 (28%) missed some return visit, the drop-off. Conclusions: The public flow of OSA diagnosis and treatment with CPAP is highly ineficiente, the not-patient-centralized agenda raises long time intervals, with a high drop-off rate.
The present study, carried out in a reference sleep service in a public hospital in the interior of the state of São Paulo, evidenced a long period of time involved in the diagnostic flow of OSAS and a difficulty in accessing CPAP machine to start treatment. These findings should encourage managers to invest in new strategies that speed up this flow and ensure patient access to CPAP, in order to increase the efficiency of the service in addressing this condition and reduce the dropout rate throughout this process.
sleep cpap long time treatment
Douglas Inomata Cardoso da Silva, Roberto Hugo Aguiar Abilio, Silke Anna Theresa Weber, Antonio Carlos Marao, Jefferson Luís de Barros, Karina Araújo dos Santos