Parthasarathy Sairam, Wendel Christopher, Grandner Michael A, Haynes Patricia L, Guerra Stefano, Combs Daniel, Quan Stuart F
University of Arizona Health Sciences Center for Sleep, Circadian, and Neuroscience Research.
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine.
Am J Respir Crit Care Med. 2025 Feb;211(2):248-257. doi: 10.1164/rccm.202309-1594OC.
Obstructive sleep apnea (OSA) is a common condition that is usually treated by continuous positive airway pressure (CPAP) therapy, but poor adherence is common and is associated with worse patient outcomes and experiences. Patient satisfaction is increasingly adopted as a quality indicator by healthcare systems. We tested the hypothesis that peer-driven intervention effected through an interactive voice response (IVR) system leads to better patient satisfaction (primary outcome), care coordination, and CPAP adherence than active control. We performed a 6-month randomized, parallel-group, controlled trial with CPAP-naive patients recruited from four centers and CPAP-adherent patients who were trained to be mentors delivering support through an IVR system. In 263 patients, intention-to-treat analysis of global satisfaction for sleep-specific services was better in the intervention group (4.57 ± 0.71 Likert scale score; mean ± SD) than in the active-control group (4.10 ± 1.13; < 0.001). CPAP adherence was greater in the intervention group (4.5 ± 0.2 h/night; 62.0% ± 3.0% of nights >4 h use) versus the active-control group (3.7 ± 0.2 h/night; 51.4% ± 3.0% of nights >4 h use; = 0.014 and = 0.023). When compared with the active-control group, the Patient Assessment of Chronic Illness Care rating was moderately increased by an adjusted difference of 0.33 ± 0.12 ( = 0.009), Consumer Assessment of Healthcare Provider and Systems rating was not different (adjusted difference, 0.46 ± 0.26; = 0.076), and Client Perception of Coordination Questionnaire was mildly better in the intervention group (adjusted difference, 0.15 ± 0.07; = 0.035). Patient satisfaction with care delivery, CPAP adherence, and care coordination were improved by peer-driven intervention through an IVR system. New payor policies compensating peer support may enable implementation of this approach. Clinical trial registered with www.clinicaltrials.gov (NCT02056002).
阻塞性睡眠呼吸暂停（OSA）是一种常见病症，通常采用持续气道正压通气（CPAP）疗法进行治疗，但依从性差很常见，且与更差的患者预后和体验相关。患者满意度越来越多地被医疗保健系统用作质量指标。我们检验了这样一个假设：通过交互式语音应答（IVR）系统实施的同伴驱动干预比积极对照能带来更好的患者满意度（主要结果）、护理协调和CPAP依从性。我们进行了一项为期6个月的随机、平行组对照试验，招募了来自四个中心的初用CPAP的患者以及接受培训成为通过IVR系统提供支持的指导者的CPAP依从性患者。在263名患者中，干预组睡眠特定服务总体满意度的意向性分析结果（4.57±0.71李克特量表评分；均值±标准差）优于积极对照组（4.10±1.13；<0.001）。干预组的CPAP依从性更高（4.5±0.2小时/晚；62.0%±3.0%的夜晚使用时间>4小时），而积极对照组为（3.7±0.2小时/晚；51.4%±3.0%的夜晚使用时间>4小时；P = 0.014和P = 0.023）。与积极对照组相比，慢性病护理患者评估评分经调整后的差异为0.33±0.12，有中度提高（P = 0.009），医疗服务提供者和系统消费者评估评分无差异（调整后的差异为0.46±0.26；P = 0.076），干预组的客户护理协调感知问卷结果稍好（调整后的差异为0.15±0.07；P = 0.035）。通过IVR系统进行的同伴驱动干预提高了患者对护理提供的满意度、CPAP依从性和护理协调性。新的支付方政策对同伴支持给予补偿可能会使这种方法得以实施。在www.clinicaltrials.gov注册的临床试验（NCT02056002）。
