Accepted for/Published in: JMIR Formative Research
Date Submitted: May 28, 2020
Date Accepted: Apr 13, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Video consultation as an adequate alternative to face-to-face consultations in CPAP use for patients with obstructive sleep apnea: a Randomized Controlled Trial.
ABSTRACT
Background:
The effectiveness of Continuous Positive Airway Pressure (CPAP) is dependent on the degree of use, so adherence is essential. Cognitive components (e.g. self-efficacy) are found to be important in predicting CPAP use. Telemedicine interventions are increasingly used to support self-management in different chronic diseases. Especially video consultation is a promising way of supporting OSA patients, and may be beneficial during treatment. So far video consultation is seldom evaluated through thorough controlled research, with only a limited number of outcomes assessed.
Objective:
To evaluate the effects of video consultation versus face-to-face consultation for patients with OSA on patients’ CPAP use (minutes/per night), self-efficacy, risk outcomes, outcome expectancies, experiences with technology and, patients’ and professionals’ satisfaction.
Methods:
A Randomized Controlled Trial was conducted with an intervention- (video consultations) and a usual care group (face-to-face consultations) with CPAP use assessments after 4, 12 and 24 weeks. Patients with confirmed OSA (AHI > 15), requiring CPAP treatment, no history of CPAP treatment, having access to a tablet/smartphone and proficiency of the Dutch language were included in the study. Patients completed questionnaires at baseline and after one month on self-efficacy, risk perception, outcome expectancies (using Self-Efficacy Measure for Sleep Apnea), expectations and experiences with video consultations (covering constructs of the Unified Theory of Acceptance and Use of Technology) and satisfaction.
Results:
In both groups CPAP use decreased over time (P=.01) similarly. No significant difference in change over time (week 4, 12 and 24) between groups was found for CPAP use (P interaction term P=.54). Self-efficacy appeared to have a statistically significant effect on CPAP use in both groups (P=.001), regardless of the intervention arm (P=.27). Patients in both groups were satisfied with the consultations and rated these respectively with an 8.4 and 8.3. The experiences with video consultation were positive, e.g. it did not cost patients effort (92%), they reported to have skills to use it (95%) and they intended to keep using it (95%). All nurses were satisfied with the quality of the sound, video and privacy and security. However, they recommended to use video consultation only in follow-up.
Conclusions:
To our knowledge, this is the first Randomized Controlled Trial that examined the effects of video consultation on CPAP use over time for newly diagnosed OSA patients in combination with cognitive components and technology acceptance. The findings of this research suggest that, for patients starting CPAP, video consultation can preferably be used in combination with an initial face-to-face consultation and especially for patients with high levels of self-efficacy. Future research should focus on blended care approaches in which self-management and especially self-efficacy is receiving greater emphasis.
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