Patient Survey Provides Insight on Sleep Apnea Treatment Preferences

A survey of patients with sleep apnea and those at high risk for it identified key aspects of the care pathway where patients have preferences that may inform future processes.

As obstructive sleep apnea (OSA) becomes more common and health care systems are challenged by increased demand for services related to the condition, identifying effective and ineffective aspects of the current system of patient management is crucial to ensure timely and effective treatment. A cross-sectional survey of patients in Australia aimed to learn which OSA care pathway features are most valued by patients with diagnosed OSA as well as those at a high risk of OSA.

“Improving access and efficiency of screening, diagnosis, and therapy is crucial to managing patients and those at risk of developing OSA,” study authors wrote. “However, the current system for managing OSA is complex and dependent on specialist services, [and is] unable to effectively meet the high and rising demand for diagnostic tests, with most individuals remaining undiagnosed and untreated in the community.”

The study, published in Applied Health Economics and Health Policy, aimed to gain insight into the preferences of potential and existing patients with OSA to inform the development of more effective pathways and increase accessibility of treatment. Previous studies have focused solely on the patient view of OSA treatments and management rather than overall pathways, according to the study authors.

The study was designed using a discrete-choice experiment (DCE) to gather input from patients that was related to the relevant importance of notable attributes in the distinct OSA care pathways throughout diagnosis, treatment, and continued care. The DCE was integrated into a web-based survey and gathered information regarding individual health care system experiences and preferences of those with OSA or a high risk of OSA.

Input from 1516 people who provided 31,794 observations overall was included in the analysis. These participants were separated into 2 cohorts: those with OSA diagnosed clinically (n = 421) and those with no formal diagnosis but who were categorized as being at high risk for the condition (n = 1033) to allow for input from patients who have engaged with the OSA pathway previously and those who have not. Patients who scored higher than 5, of a maximum of 10, in the OSA-50 Screening Questionnaire were considered high risk.

The pathway items in the DCE included the initial assessment provider, sleep study setting, diagnosis costs, waiting times, results interpretation, treatment options, provider of ongoing care, and frequency of follow-up visits.

All 8 attributes were statistically significant to respondents, with the least preferred options in general being:

  • “Dentist” for initial assessment provider
  • “No sleep study/nowhere” for test setting
  • “Longer than 3 months” for waiting time
  • “Dentist or ear, nose, throat (ENT) surgeon” for result interpretation
  • “Throat surgery” for treatment option
  • “No one” for the ongoing care provider

The group with diagnosed OSA preferred a general practitioner for the initial OSA assessment, sleep studies conducted in a public hospital and done on the same day, and minimum out-of-pocket costs. For result interpretation and ongoing care, the preference was a sleep specialist. Continuous positive airway pressure was the preferred treatment option.

The undiagnosed high-risk group also preferred a general practitioner for initial assessment as well as minimum diagnostic costs, no waiting time for a sleep study, fewer ongoing care visits, and a sleep specialist to interpret their sleep study results. In contrast to the OSA group, undiagnosed patients would prefer a sleep study and ongoing care to take place in a primary care setting and prefer lifestyle changes as their treatment option, followed by a mouthguard.

Primary care providers were the preferred practitioners for initial assessment across the cohorts, and this information may help given the shortage of sleep specialists. However, their minimal expertise and lack of pathways for complex or treatment-resistant patients could present challenges. Ensuring they have the skills and knowledge to diagnose and manage OSA would be paramount. Therefore, further steps are needed to improve general practitioner education and training with OSA diagnosis and therapy.

Another notable result was that all treatment options, except for surgical intervention, were seen positively by patients. Surgery scored lower than no treatment at all.

“In general, all of the attributes were deemed essential,” the authors wrote. “However, the relative importance is different for the 2 groups, except for the diagnostic costs and ongoing care frequency, which were preferred to be low and the initial assessment and result interpretation providers who remain unvaried in both groups.”

Although the current OSA care pathways are complex and often challenging for patients, input from patients in studies such as this one can help develop new models for sleep service delivery and may help with the ongoing problems and continuity of care associated with current pathways, the authors concluded.

Reference

Natsky AN, Vakulin A, Chai-Coetzer CL, McEvoy RD, Adams RJ, Kaambwa B. Preferred attributes of care pathways for obstructive sleep apnoea from the perspective of diagnosed patients and high-risk individuals: a discrete choice experiment. Appl Health Econ Health Policy. Published online February 10, 2022. doi:10.1007/s40258-022-00716-1