Personalized Patient Pathway to Improve Outcomes in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a debilitating disorder that can be symptomatic or not and is accompanied by major neurocognitive and cardiovascular sequelae. Its prevalence rate is around 21-26% and increases every year with a significant impact on the health system. The standard of care is called continuous positive airway pressure (CPAP). Despite the effectiveness of the treatment, 30 to 60% of treated patients are not adherent. OSA complications might result in sudden death, stroke or heart arrhythmia leading additional care cost for the healthcare system.

Clinical studies have demonstrated the effectiveness of personalized treatment to improve adherence among CPAP-treated patients. Unfortunately, those studies only focus on medical device and not the patient itself.

PIMA has the ability to individualize the treatment according to specific patient’s needs.

Goal: Improving the adherence of CPAP treatment in order to enhance patient’s outcomes such as sleepiness, mood, activities and social relationships.
Firstly, certain socio-demographic characteristics are taken (age, level of education, use of technologies, accessibility). Then, a specific educational and training program called MEntA (Motivational Interview Adherence) is performed. It allows the patient to better integrate the most elementary aspects for adherence: knowledge of OSA and habits, self-efficacy, and use.
Besides, a questionnaire with psychometric validation has been developed and allows knowing the level of self-efficacy by the patient in order to monitor the therapy. This questionnaire works as a therapeutic interview that helps maintain dialogue between the Air Liquide nurse and the patient.

Hence, PIMA starts from a patient segmentation in order to initiate the best care plan that adapts both to their personal characteristics and to the situation related to the therapy. Each care plan has different monitoring channels (face-to-face, home visit, Air Liquide assistance corner, video-conference, …). It is worth noticing that during follow-up, a patient may require changes in care plans whether an improvement or decrease in adherence occurs. Outcomes of the patients such as degree of sleepiness, mood, activities, social relationships, and overall QoL are measured during each follow up moment.

This flexibility and adaptation also allows benefits in treatment costs. The IPU is composed with one psychologist specializing in communication skills and psychometric methodology, nurses and physiotherapists, hospital pulmonologists, and technical trained personnel able to deal with diverse incidents.

With 3 randomized control trial, we demonstrated that PIMA increase significantly adherence (2 hours per day) and quality of life compared to previous care pathway.

Since November 2019, PIMA has been the standard treatment in patients with OSA at the Central University Hospital of Asturias (Spain). The implementation of this program has been carried out in two stages: during 2020 it was done with all new patients (621 patients), and since December 2020, old patients are being migrated from the classic care plan to PIMA.