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14-03-2013 | General practice | Article

Primary and specialist care comparable for obstructive sleep apnea

Abstract

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medwireNews: Primary care management of obstructive sleep apnea is comparable to that provided in a specialist sleep center, with possible lower costs, study findings show.

The primary outcome of 6-month change from baseline in Epworth Sleepiness Scale (ESS) score was similar between the two types of care, with mean reductions of 5.8 for patients managed in a primary care setting and 5.4 for those treated in specialist centers, giving an adjusted difference in the mean change of -0.13.

Also, analysis of within-trial costs showed that primary care management of obstructive sleep apnea was approximately 40% less expensive than specialist care.

"Thus, with adequate training of primary care physicians and practice nurses and with appropriate funding models to support an ambulatory strategy, primary care management of obstructive sleep apnea has the potential to improve patient access to sleep services," say Ching Li Chai-Coetzer (Repatriation General Hospital, Daw Park, Australia) and colleagues.

"This would be particularly beneficial for rural and remote regions, as well as developing nations, where access to specialist services can be limited."

The study, published in JAMA, involved 155 patients with obstructive sleep apnea and daytime sleepiness who were randomly assigned to treatment at primary care practices (n=81) or sleep centers (n=74). Management in both groups included continuous positive airway pressure (CPAP), mandibular advancement splints, or conservative measures only.

In the primary care group, mean ESS scores decreased from a baseline score of 12.8 (out of a possible 24) to 7.0 at 6 months. Similarly, mean ESS scores for the specialist center group fell from 12.5 to 7.0.

The two groups were also similar for secondary outcome measures, including adherence to CPAP and overall patient satisfaction, but withdrawal rates were higher among patients receiving primary care, the reasons for which were unclear, says the team.

The total average costs per patient were estimated to be AU$ 1606 (US$ 1819; € 1398) in the primary care group and AU$ 2576 (US$ 3068; €2357) in the specialist group. The increased costs for the latter group were primarily attributed to sleep physician consultations and travel costs.

"However, our study reports within-trial sleep management-related costs only and not indirect costs nor does it assess the longer-term economic implications of an ambulatory strategy in primary care," the team notes.

By Lucy Piper, Senior medwireNews Reporter

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