Patient Education: A Multi-Level Process

We are all aware of the staggering failure rate among diagnosed obstructive sleep apnea patients.

According to Edward Grandi, executive director of the American Sleep Apnea Association, the patient compliance rate for continuous positive airway pressure is still an alarming 50 to 60 percent. That number is comprised of patients who are diagnosed with sleep apnea and refuse treatment as well as those who try treatment and then abandon that therapy.

Patient education is the foremost factor in improving compliance. If patients knew the facts about OSA and received education from the medical professionals who are involved in the screening, diagnosis and treatment processes, the compliance rate would substantially improve.

Patient education is my chosen profession — a privilege that has allowed me to correspond with hundreds of patients in person, by phone and email every month over the past decade. I hear the same theme from the non-compliant: “No one ever told me that.”

Roughly 25 percent of the patients I educate are those newly diagnosed and in the difficult adjustment period. Many are on the verge of giving up. Fifty percent have struggled with compliance for a year or more without realizing the benefit of therapy.

They present as frustrated, angry and at their wits-end with the lack of concern by physicians and home health care providers. This group knows it needs the therapy but does not know how to become successful.

The other 25 percent are people who abandoned therapy years ago and are considering giving CPAP another try as they have since developed serious comorbidities such as irregular heart beat, hypertension, heart attack or stroke, reluctantly forcing them back to treatment.

Some are just tired of being tired and are willing to give it another chance. A surprising number tell me that they experienced drastic weight loss or had nasal, jaw or airway surgeries that did not result in the cure they expected.

TYPICAL SCENARIO

After diagnosis, a patient is sent to local home medical equipment provider where he or she is presented with a CPAP device and mask. Often, mask choice is not given nor is much time spent with a patient to show fit and adjustment features. Patients are shown how to turn the device on and off and sent on their way to fend for themselves.

Most are not made aware of the devastating nature of untreated apnea, a key factor in encouraging therapeutic compliance. Follow-up and education on equipment care with replacement information is typically non-existent.