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Effects of implementation of telemonitoring and educational counseling on CPAP adherence in the context of public health
The gold standard treatment for Obstructive Sleep Apnea (OSA) is the use of CPAP (Continuous Positive Airway Pressure), which despite its high resolution, has a high cost and low adherence. The public health system of Lavras-MG provides CPAP therapy to all diagnosed OSA patients. This is a highly costly service for the primary health care system and no follow-up was done until the implementation of the Oxigenotherapy program. The first action of the program was to implement an education and telemonitoring of CPAP use.
To evaluate the impact of the implementation of educational support and telemonitoring on CPAP adherence in OSA patients attended by the program.
Fifty-four OSA patients enrolled in the Oxigenotherapy Program of Lavras-MG were included in the study. The study was approved by the Ethics Committee of the Federal University of Lavras (protocol n.: 4.684.230). The telemonitoring and educational counseling were implemented in July 2021 by the research team. Patients received a visit from a researcher and were advised regarding the minimal adherence of CPAP to have benefits, the importance of correct use of masks, and equipment hygiene. The percentage of CPAP use (higher than 4h per night) was evaluated before and after the implementation of the program. Adherence was considered usage higher than 70% in the last month.
The mean age of the participants were 59,61±12,68 years, 48% (n= 26) were male and 52% (n= 28) were female. At initial evaluation, 63% of the patients adhered to CPAP use (used the equipment for a minimum of 4h per night), and 37% had no adherence to the treatment. After the intervention, the adherence increased to 64,8%. Regarding the sex of the participants, there were no changes in adherence between men, while an increase in adherence of 3,57% was observed in the female sex. An increase in the percentual of CPAP use was observed in 10 patients, although they did not achieve the 70%. In those, the mean percentage of use (higher than 4h/night) increased from 33,4% to 61,4% after the intervention.
The inclusion of a simple orientation and effectively telemonitoring of CPAP adherence in the short term represent an important impact on treatment adherence. Long-term and multidisciplinary educational programs are necessary to increase CPAP adherence in the public health system to increase cost-effectiveness.
Sleep Apnea Obstructive, Continuous Positive Airway Pressure, Adherence.
Universidade Federal de Lavras - Minas Gerais - Brasil
Luiz Gustavo Dos Santos, Hianka Simone Pereira Dos Reis, Lídia Lopes Pereira, João Vitor da cunha Agostini, Evelise Mendonca Barreto, Maysa Helena De Aguiar Toloni, Camila Maria De Melo