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Background/purpose: Patients with sleep apnea are often prescribed positive airway pressure (PAP) treatment. Some patients have difficulty consistently using a PAP machine due to problems such as air leak, mask discomfort, and dry mouth. Sleep medicine is growing rapidly, and the role of the ambulatory care registered nurse (RN) in the care of this population is evolving.
The purpose of this project is to evaluate the satisfaction and efficacy of a PAP troubleshooting clinic lead by a RN and a respiratory technician (RT). This clinic seeks to improve PAP compliance, increase PAP tolerability, increase PAP treatment efficacy, and assist sleep medicine physicians and advanced practice providers (APP) in the delivery of high-quality, efficient care of the sleep apnea patient.
Method/approach: The PAP troubleshooting clinic consists of a RN and RT with specialized knowledge about sleep apnea and PAP treatment. During a 30- or 60-minute clinic visit, these providers review the patient’s experience with PAP, assess mask fit, review PAP data and PAP settings, and recommend treatment adjustments for the primary sleep clinic provider’s consideration. Outcomes assessment includes satisfaction (a telephone survey one week after the visit) and efficacy (30-day data on overall use, mask leak, and days with ≥ 4 hours of use downloaded from PAP machines). To evaluate outcomes, patients receive a telephone call one week after the visit to assess ongoing success or failure post-visit. We estimated efficiency by calculating time of visits that would have otherwise required physician or APP.
Results: To date, 58 patients have received care in the clinic, and 56 (96.5%) patients reported they were satisfied/highly satisfied with the PAP troubleshooting clinic. From the sample, 43 (74.1%) patients were compliant with mask use over 30 days. 24 (55.81%) showed a greater than 10% reduction in mask leak after intervention. Ten patients (23.3%) achieved an improvement with a 10% increase in number of days with > than 4 hours of PAP use. Current patients continue to be monitored by the team and the clinic sees and monitors new patients. An estimated 55 hours of clinic time were reallocated from physicians and advanced practitioners to the RN and RT.
Discussion: Both patients and sleep clinic providers are very satisfied with the PAP troubleshooting clinic. Patients are referred to this clinic because they have significant issues with PAP usage and are at high risk of discontinuing use. Patients find the clinic helpful and encouraging, while sleep medicine physicians and APPs appreciate the assistance in helping patients succeed with PAP, especially during the 30-day time period where PAP compliance receives scrutiny from clinics and payers. A PAP troubleshooting clinic with a specialty-trained RN and RT is an effective way to improve patient PAP use, mask leak, prolonged use, and patient satisfaction. Importantly, this new clinical model offers a valuable alternative to provide patients with the appropriate level of care.
