Stansbury Robert, Rudisill Toni, Salyer Rachel, Kirk Brenna, De Fazio Caterina, Baus Adam, Aryal Shubekchha, Strollo Patrick J, Sharma Sunil, Feinberg Judith
Section of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, WV 26506, USA.
Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
J Clin Med. 2022 Jul 30;11(15):4449. doi: 10.3390/jcm11154449.
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. 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. 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. 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.
西弗吉尼亚州（WV）的肥胖率和心肺疾病发病率在美国最高。最近的研究发现，该州在阻塞性睡眠呼吸暂停（OSA）的护理方面存在显著差距。鉴于该地区肥胖率和心肺疾病发病率较高，这种OSA护理差距可能对该地区的健康产生重大影响。这项混合方法研究的目的是确定导致此前在WV发现的农村OSA护理差异的障碍。本研究采用混合方法，评估西弗吉尼亚州南部社区的联邦合格健康中心在OSA管理方面的障碍和促进因素。在为阿巴拉契亚社区服务的联邦合格健康中心与医疗服务提供者进行了焦点小组讨论。参与者还完成了经过验证的阻塞性睡眠呼吸暂停知识与态度（OSAKA）问卷，以深入了解医疗服务提供者对OSA的知识和信念。在各地点完成了使用诊断代码的电子病历分析，以评估OSA患病率。在所有焦点小组讨论中由同一个人担任访谈员，以尽量减少访谈员差异/偏差。我们的团队进行了抽查，以确保专业转录正确且与音频匹配。从焦点小组中确定的主题分为三大类：（1）OSA护理提供的障碍，（2）OSA护理提供的促进因素，以及（3）基于社区的护理需求，以优化目标农村地区的OSA管理。问卷数据显示，农村医疗服务提供者认为OSA是一个需要识别的重要病症，但缺乏识别和治疗OSA的信心。对电子病历的评估表明，这些农村社区的OSA护理差距比之前描述的还要大。这项研究发现，医疗服务提供者对有效诊断和治疗OSA的能力缺乏信心，并确定了在所研究社区中限制OSA护理的具体主题。针对已确定的知识差距和新技术的培训可能会让农村初级保健提供者有信心在OSA诊断和管理中发挥更积极的作用。将初级保健提供者、专科医生和有效利用现代技术纳入其中的综合护理模式，对于解决西弗吉尼亚州农村地区以及美国其他类似社区中已确定的OSA护理差异至关重要。像本研究这样的社区参与研究对于为为患有OSA和其他呼吸道疾病的农村社区提供服务的医疗服务提供者创建可行、实用、相关且具有文化胜任力的护理途径以实现健康公平至关重要。
