Chiu Judy, Fenton Mark, Ayas Najib T, Povitz Marcus, Almeida Fernanda, Huynh Nelly, Kendzerska Tetyana, Ratycz Diana, Bansback Nick, Pendharkar Sachin R
Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Division of Respirology, Critical Care, and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Ann Am Thorac Soc. 2023 Jan;20(1):110-117. doi: 10.1513/AnnalsATS.202205-390OC.
Funding for obstructive sleep apnea (OSA) treatment may impact how patients access care, wait times, and costs of care. The aim of this study was to compare differences in diagnosis and treatment of OSA between Canadian jurisdictions with and without public funding for continuous positive airway pressure (CPAP). We administered an anonymous internet survey to Canadian adults reporting a physician diagnosis of OSA. Responses were categorized on the basis of whether the respondent's province provided full or partial funding for CPAP therapy for all patients. We assessed wait times for diagnosis and treatment, patient-borne costs, and model of care delivery compared between jurisdictions with and without universal CPAP funding. We received 600 responses representing all Canadian provinces and territories. The median (interquartile range) age was 59 (49-66) years; 57% were male, and 21% were from rural settings. Patients living in provinces without public CPAP funding ( = 419) were more likely to be diagnosed using home sleep apnea testing (69% vs. 20%; = 0.00019). Wait times were similar after adjustment for demographics, disease characteristics, and model of care. Although patient-borne costs of care were similar between jurisdictions, patients from regions without CPAP funding reported that cost had a greater influence on the choice of therapy. Sleep specialists were more commonly involved in OSA care in regions with CPAP funding. There was no difference in the current use of therapy between jurisdictions with and without public funding. This survey study demonstrates that public funding for CPAP therapy impacts how Canadians access OSA care but is not associated with differences in wait times or costs. Future research is required to determine the impact of different funding models for OSA care on clinical outcomes.
阻塞性睡眠呼吸暂停（OSA）治疗的资金投入可能会影响患者获得治疗的途径、等待时间以及治疗费用。本研究的目的是比较加拿大有和没有为持续气道正压通气（CPAP）提供公共资金的司法管辖区之间OSA诊断和治疗的差异。我们对报告有医生诊断为OSA的加拿大成年人进行了一项匿名网络调查。根据受访者所在省份是否为所有患者提供CPAP治疗的全部或部分资金，对回答进行分类。我们评估了有和没有普遍CPAP资金的司法管辖区之间的诊断和治疗等待时间、患者自付费用以及护理提供模式。我们收到了代表加拿大所有省份和地区的600份回复。年龄中位数（四分位间距）为59（49 - 66）岁；57%为男性，21%来自农村地区。生活在没有公共CPAP资金的省份的患者（= 419）更有可能通过家庭睡眠呼吸暂停测试进行诊断（69%对20%；= 0.00019）。在对人口统计学、疾病特征和护理模式进行调整后，等待时间相似。尽管各司法管辖区患者自付的护理费用相似，但来自没有CPAP资金地区的患者报告称，费用对治疗选择的影响更大。在有CPAP资金的地区，睡眠专家更常参与OSA护理。有和没有公共资金的司法管辖区之间目前的治疗使用情况没有差异。这项调查研究表明，CPAP治疗的公共资金投入会影响加拿大人获得OSA护理的方式，但与等待时间或费用的差异无关。需要进一步的研究来确定不同的OSA护理资金模式对临床结果的影响。
