Regional differences in PAP care: more questions than answers

Billings, Martha E.

doi:10.5664/jcsm.9106

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…The majority of providers stated they refer to specialty sleep centers or specialists for diagnostic testing and treatment, but given healthcare access issues in these communities related to patient financial constraints, transportation issues and geographic isolation, this approach alone cannot address the OSA disparities in rural WV and in other rural settings. Similar challenges have been identified in rural communities both inside and outside the United States [ 14 , 24 , 25 , 26 ]. Implementation of a three-pronged strategy may provide a possible solution to this issue of limited access decreasing this inequity in the targeted region and other rural areas.…”

Section: Discussionmentioning

confidence: 53%

Provider Perspectives on Sleep Apnea from Appalachia: A Mixed Methods Study

Stansbury

Rudisill

Salyer

et al. 2022

JCM

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West Virginia (WV) has the highest rates of obesity and cardiopulmonary disease in the United States (U.S.). Recent work has identified a significant care gap in WV for obstructive sleep apnea (OSA). This OSA care gap likely has significant health implications for the region given the high rates of obesity and cardiopulmonary disease. The purpose of this mix methods study was to identify barriers that contribute to the rural OSA care disparity previously identified in WV. Methods: This study used mixed methods to evaluate the barriers and facilitators to management of OSA at Federally Qualified Health Centers serving communities in southern WV. Focus groups were conducted at federally qualified health centers with providers serving Appalachian communities. Participants also completed the validated Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire to gain insight into provider knowledge and beliefs regarding OSA. EMR analysis using diagnostic codes was completed at the sites to assess OSA prevalence rates. The same individual served as the interviewer in all focus group sessions to minimize interviewer variability/bias. Our team checked to ensure that the professional transcriptions were correct and matched the audio via spot checks. Results: Themes identified from the focus groups fell into three broad categories: (1) barriers to OSA care delivery, (2) facilitators to OSA care delivery, and (3) community-based care needs to optimize management of OSA in the targeted rural areas. Questionnaire data demonstrated rural providers feel OSA is an important condition to identify but lack confidence to identify and treat OSA. Evaluation of the electronic medical record demonstrates an even larger OSA care gap in these rural communities than previously described. Conclusion: This study found a lack of provider confidence in the ability to diagnose and treat OSA effectively and identified specific themes that limit OSA care in the communities studied. Training directed toward the identified knowledge gaps and on new technologies would likely give rural primary care providers the confidence to take a more active role in OSA diagnosis and management. An integrated model of care that incorporates primary care providers, specialists and effective use of modern technologies will be essential to address the identified OSA care disparities in rural WV and similar communities across the U.S. Community engaged research such as the current study will be essential to the creation of feasible, practical, relevant and culturally competent care pathways for providers serving rural communities with OSA and other respiratory disease to achieve health equity.

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Section: Discussionmentioning

confidence: 53%

Provider Perspectives on Sleep Apnea from Appalachia: A Mixed Methods Study

Stansbury

Rudisill

Salyer

et al. 2022

JCM

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“…To inform our proposed analysis assessing the effect of PAP utilization exposure groups, we first observed the distribution of total PAP claims per patient at the end of first year of PAP utilization ( Supplemental Figure 3 ). PAP claim counts showed a bimodal distribution, suggesting two utilization patterns were more prevalent: a mode on 3 claims and a mode on 14 claims, which may be suggestive of CMS PAP reimbursement models 46 and may correlate with PAP adherence 47,48 . Because Medicare claims databases do not include PAP adherence tracking, we explored different PAP exposure group definitions (see PAP utilization definitions and Supplemental Figure 4 ) to determine relevant cut-offs in the distribution of PAP claims.…”

Section: Resultsmentioning

confidence: 96%

Positive Airway Pressure Therapy Predicts Lower Mortality and Major Adverse Cardiovascular Events Incidence in Medicare Beneficiaries with Obstructive Sleep Apnoea

Mazzotti

Waitman

Miller

et al. 2023

Preprint

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Background: Obesity is associated with obstructive sleep apnoea (OSA) and cardiovascular risk. Positive airway pressure (PAP) is the first line treatment for OSA, but evidence on its beneficial effect on major adverse cardiovascular events (MACE) prevention is limited. Using claims data, the effects of PAP on mortality and incidence of MACE among Medicare beneficiaries with OSA were examined. Methods: A cohort of beneficiaries (>65 years) with ≥5 years of consecutive enrolment to Medicare and ≥2 distinct OSA claims was defined from multi-state, state-wide, multi-year (2011-2017) Medicare fee-for-service claims data. Evidence of PAP initiation and utilisation was based on PAP claims after OSA diagnosis. MACE was defined as a composite of myocardial infarction, heart failure, stroke, or coronary revascularisation. Doubly robust Cox proportional hazards models with inverse probability of treatment weights estimated treatment effects controlling for sociodemographic and clinical factors. Results: Among 225,132 beneficiaries with OSA (median age 74 years; 45.3% women; median follow-up 3 years), those with evidence of PAP initiation (50.1%) had significantly lower all-cause mortality (HR [95%CI]: 0.57 [0.56-0.59]) and MACE incidence risk (0.90 [0.88-0.92]). Higher quartiles of annual PAP claims were progressively associated with lower mortality (Q2: 0.80 [0.75-0.86], Q3: 0.68 [0.64-0.72], Q4: 0.65 [0.61-0.70]) and MACE incidence risk (Q2: 0.91 [0.86-0.97], Q3: 0.87 [0.82-0.91], Q4: 0.85 [0.80-0.90]). Conclusion: PAP utilisation was associated with lower all-cause mortality and MACE incidence among Medicare beneficiaries with OSA. Results might inform trials assessing the importance of OSA therapy towards minimising cardiovascular risk and mortality in older adults.

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Regional differences in PAP care: more questions than answers

Cited by 2 publications

References 21 publications

Provider Perspectives on Sleep Apnea from Appalachia: A Mixed Methods Study

Provider Perspectives on Sleep Apnea from Appalachia: A Mixed Methods Study

Positive Airway Pressure Therapy Predicts Lower Mortality and Major Adverse Cardiovascular Events Incidence in Medicare Beneficiaries with Obstructive Sleep Apnoea

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