JMIR Publications

ABSTRACT

Background:

Sleep apnea is a significant public health disease in Finland with a prevalence of 3.7%. Continuous positive airway pressure (CPAP) therapy is the first-line treatment of moderate or severe sleep apnea. Since November 18, 2019, all patients starting their CPAP therapy in Oulu University Hospital have been attached to a sleep apnea digital care pathway (SA-DCP) and instructed on how to take it into use. Nevertheless, there were still patients who did not use the SA-DCP.

Objective:

To study healthcare professionals’ (HCPs) perspectives on the SA-DCP and its usefulness for their work. To study whether it is possible to reach the main targets of the SA-DCP, i.e., to shorten the initial guiding sessions of CPAP therapy, reduce patient calls and contacts with HCPs, and improve patients’ adherence to CPAP therapy. To study the patients' perspectives of the SA-DCP and its usefulness for them.

Methods:

Six HCPs were interviewed in 5–6/2021. The survey for SA-DCP users (n=58) and nonusers (n=33) was carried out in 5–8/2021 and in 1–6/2022. CPAP device remote monitoring data was collected from SA-DCP users (n=80) and nonusers (n=90) in 5/2021. The register data of phone calls was collected from the years 2019, 2020, and 2021. Feedback on the SA-DCP was collected from 446 patients between 2–3/2022.

Results:

According to HCPs, the introduction of the SA-DCP had not yet brought significant improvements to their workload and work practices, but in some situations, it had brought more flexibility. A larger proportion of SA-DCP users had familiarized themselves with prior information about CPAP therapy before the initial guiding session of CPAP therapy than nonusers (43/58, 74% vs. 16/33, 49%; P=.022). There were still patients without prior information about CPAP therapy, so most of the sessions were carried out according to their needs. According to the patient survey and remote monitoring data of CPAP devices, CPAP adherence was high among both SA-DCP nonusers and users. The number of patients’ phone calls to HCPs had not decreased during the study. SA-DCP users perceived their own abilities to use information and communication technology to be better than nonusers (mean 4.2, SD 0.8 vs mean 3.2, SD 1.2; P<.001)

Conclusions:

According to this study, not all the goals set for the introduction of the SA-DCP had been achieved. Despite the use of the SA-DPC, some patients still wanted to communicate with HCPs via phone calls. The most significant factors explaining the non-use of the SA-DCP were patients' lower digital literacy and older age. In the future, more attention should be paid to how these user groups are considered in the design and introduction of upcoming digital care pathways.