Telehealth Services to Improve Nonadherence: A Placebo-Controlled Study

ArticleinTelemedicine and e-Health 12(3):289-96 · July 2006with25 Reads
DOI: 10.1089/tmj.2006.12.289 · Source: PubMed
Abstract
The objective of this study was to test whether a telehealth intervention could improve the compliance with continuous positive airway pressure (CPAP) by patients with sleep apnea. These patients had been nonadherent for the initial 3 months of therapy even after receiving the initial standard and then supplemental audiotaped/videotaped patient education for adhering to CPAP nightly. The materials and methods included a randomized testing of experimental and placebo interventions. Interventions were delivered by nurses to two groups in their homes by telehealth over a 12-week period. The placebo intervention was used to control for Hawthorne effect, time and attention influences and the novelty of having telehealth in the home. Results following the telehealth interventions were that significantly more patients in the experimental group 1 (n = 10) than the placebo group 2 (n = 9) were adhering nightly to CPAP (chi 2 = 4.55, p = 0.033). Group 1 patients reported greater satisfaction with their intervention. However, both groups rated telehealth delivery positively. The mean cost of each 20-minute telehealth visit was 30 dollars while the total cost of the telehealth intervention for each patient was 420 dollars. These costs included telehealth equipment, initial installation, longdistance telephone charges, nurse salary, and intervention materials. Conclusions are that telehealth interventions are a potentially cost-effective service for increasing adherence to prescribed medical treatments. Replication studies with large samples and in other clinical groups are recommended.
    • "). This service model has been used to address a wide variety of clinical concerns including but not limited to compliance with treatment for sleep apnea (Smith et al. 2006), pain management (McGeary et al. 2012), weight maintenance (Haugen et al. 2007), post-traumatic stress (Sloan et al. 2011 "
    [Show abstract] [Hide abstract] ABSTRACT: Interest in procedural fidelity has grown rapidly since 1981 as evidenced by the growing numbers of research publications across disciplines on this topic. As a result, the past 30 years of research has yielded a variety of procedures to guide research and practice, which we hope translates into better educational practices and services. Despite our progress, much remains unknown. As an introduction to the special issue on advancements in procedural fidelity, this article will briefly describe the conceptual and definitional issues surrounding this topic, summarize the relevance of procedural fidelity to education and research, and highlight the articles in this issue that address proposed research priorities.
    Full-text · Article · Mar 2013
    • "Despite the organizational limitations and poor differences between intervention and control group follow-up, they obtained good patients' acceptance of this monitoring strategy. It is also noteworthy that telehealth interventions, such as longdistance visit via videoconference (or " televisits " ), have been found to improve CPAP adherence in a small group of nonadherent patients versus a placebo-controlled group [12]. The cost of the interventions, including the telehealth monitor, home installation and telephone charges, was lower than the same number of face-to-face visits. "
    [Show abstract] [Hide abstract] ABSTRACT: Patient's compliance is crucial for the effectiveness of continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA). Unfortunately, up to 50% of patients withdraw CPAP because of treatment side effects. Monitoring a patient's CPAP compliance at home would be useful to early detect underuse and to properly address problems. Air Liquide developed NOWAPI, a novel telemedicine system, which provides a remote monitoring of the CPAP treatment and is designed to be compatible with all CPAP devices under clinical use. The aim of this study was to validate this novel telemonitoring system in a bench test. NOWAPI detects important CPAP treatment efficiency parameters, such as the usage time and residual events, and sends them to a secure server, from which can be downloaded for analysis by the healthcare staff. In this study, NOWAPI was tested when using CPAP devices applied to a model simulating OSA patients. In a first test phase, to assess the influence of NOWAPI sensor unit geometry to the CPAP treatment, the responses of 2 different CPAP machines to a series of 10 disturbed breathing patterns with NOWAPI connected or not to the setting was compared. Then, the telemedicine system performance was tested in 30 simulated patients' sleep periods of CPAP treatment, lasting 4 hours each. They consisted of disturbed breathing patterns built from selected events of real OSA patients' polysomnographic recordings. The recorded data of each test were telemetrically sent to a server by the NOWAPI GPRS module, then downloaded and analyzed. The simulated patients were treated with 3 different currently available CPAP devices. NOWAPI sensor unit connection to the setting did not influence the CPAP treatment in the two CPAP devices analyzed. The difference between the treatment duration estimated by the device and actual values was never higher than 3 minutes over the 4-hour test. The absolute difference between the apneahypopnea index estimated by NOWAPI and the actual values, 0.9±1.6 events/hour (mean±SD), was not significantly different from the absolute difference between the AHI estimated by the CPAP machines and the actual values, 0.9±1.0 events/hour (p=0.171). NOWAPI showed an excellent performance in estimating the duration of the CPAP treatment and in detecting residual respiratory events in simulated OSAS patients. NOWAPI system could be a valuable tool for telemonitoring the treatment of obstructive sleep apnea.
    Article · Jan 2013
    • "Recently, other methods have been evaluated, some including wireless telemonitoring [50], to monitor the pattern of use by each patient and to target supportive interventions on an individual basis. These interventions, when combined with real-time assessment of PAP use, may have greater benefit [47, 51] . In contrast, an educational strategy alone had little impact in improving PAP adherence [52]. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Auto-titrating continuous positive airway pressure (APAP) is an effective treatment for obstructive sleep apnea/hypopnea syndrome (OSAHS). We investigated whether a single group education session on APAP therapy is effective in promoting adherence among patients with OSAHS. Methods: This prospective, randomized, controlled, parallel group study included patients newly diagnosed with OSAHS who met criteria for APAP therapy. Patients were randomized into a study group and a control group. All patients in the study group were assigned to a single group education session, 1 month after beginning APAP therapy. Results: We evaluated 146 patients. The median percentage of APAP usage days was 88.3 %, with a median duration per day of use of 6.02 h; 59 % were classified as adherent. Overall, no significant difference in adherence was seen between the study and the control groups. Analyzing patient subgroups, the group session significantly improved APAP adherence among males and patients who were younger (<65 years old), obese (BMI ≥ 35 kg/m(2)), non-sleepy (Epworth sleepiness scale ≤ 11), smokers or past smokers, had hypertension or nocturia and those with non-severe OSAHS. Conclusion: To maximize the impact of group education sessions and, by that, saving resources, it may be important to select patients likely to benefit from these sessions.
    Full-text · Article · Nov 2012
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