Patient Empowerment–Obstructive Sleep Apnea: Impact of Behavior Change Coaching on OSA Patient Adherence to Prescribed Positive Airway Pressure Therapy in the In-Patient Setting

Abstract

Background:

The established treatment for most OSA patients is PAP, for prevention of apnea due to upper airway collapse while sleeping. OSA patients are often not compliant with prescribed PAP therapy, most sources state adherence rates of 50% or less. Non-adherence to PAP impacts both long term health, as well as patient safety. When admitted to the hospital the sedative effects of anesthesia, and additional medications increase these risks. Patient Empowerment is a behavior change interaction administered by trained Respiratory Care Practitioner Coaches. This interaction is known to facilitate behavior change by impacting patient engagement and activation leading to patient empowerment. We sought to investigate the effects of a Patient Empowerment coaching on the inpatient adherence of OSA patients to prescribed PAP therapy.

Methods:

Patient Empowerment coaching for OSA patients was implemented at Sharp Memorial Hospital in June 2018. The interaction has four phases: Building Rapport, Engagement, Facilitating Activation, and Empowerment. The coach uncovers implementational, as well as motivational factors that may be barriers to PAP use. The former may include interface issues such as mask type and fitting. The motivational factors are aspects where patient behavior is not in line with medical recommendations. Patients are often not absolutely refusing, they are rather in a state of ambivalence. The role of the coach is to build rapport and engage the patient in exploring and resolving their ambivalence. PAP adherence data from a 2-week period, August 1-14, 2017 (pre-intervention) was compared to the same period the following year August 1-14, 2018 (post-intervention). Adherence was defined as documented evidence of PAP therapy. A comparison was made of total nights PAP was ordered, to the total nights adhered to for each group. A two-sample t-test between proportions was performed to determine whether there was a significant difference between the groups. The Sharp Institutional Review Board approved this research as not subject to regulation.

Results:

There was a statistically significant increase in PAP adherence rates of patients receiving Patient Empowerment coaching, when compared to the pre-intervention time period. (87.4%, 46.7%, P < .001) (Table 1) Conclusions: In our cohort, Patient Empowerment coaching had a positive impact on the PAP therapy adherence rate of inpatient OSA subjects. Disclosures: None