0523 Increased CPAP Adherence Over Twelve Months Associated with Phone-Based Behavior Change Coaching

• Published in: Sleep (New York, N.Y.) Vol. 42; no. Supplement_1; p. A209
• Main Authors: Bakker, Jessie P, Stitt, Christy, Jasko, Jeff, Hardy, William, Como, Anthony, Aloia, Mark
• Format: Journal Article
• Language: English
• Published: Westchester Oxford University Press 13.04.2019
• Subjects: Coaching; Continuous positive airway pressure; Patients; Telemedicine
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsz067.521

Introduction Research suggests that adherence to continuous positive airway pressure (CPAP) declines following withdrawal of an intervention designed to increase usage. We have developed Patient Adherence Management Service (PAMS), a central call-center with staff trained in health behavior change, to provide personalized coaching based on motivational enhancement principles for patients beginning CPAP in the clinical setting. We retrospectively examined adherence for up to 12-months between patients who underwent the intervention for 365-days (Coaching-365), those who underwent the intervention for 90-days and then continued CPAP without further support (Coaching-90), and those who started CPAP without the intervention (Coaching-0; usual care). Methods A blinded analyst retrieved 180-365 nights of usage data for all Coaching-365 patients in our database (n=136), as well as randomly selected patients in the Coaching-90 and Coaching-0 groups (n=16,691 each), propensity-matched for age, gender, and CPAP start-date. Nights with no usage were imputed with 0 hours/night. We modeled adherence (hours/night) including the between-subject factor of group and repeated-measure factor of time, adjusted for age and gender, and examined a group-by-time interaction. Results The sample (58% male) had a mean ± standard deviation (SD) age of 57±14 years. Over days 0-90, the mean ± standard error (SE) adjusted adherence was 5.5±0.3, 4.8±0.02, and 3.6±0.02 hours/night in the Coaching-365, Coaching-90, and Coaching-0 groups, respectively. Modeling up to 12-months per patient, we observed significant main effects for group and time, and a significant group-by-time interaction (all <0.001). The difference between groups persisted over 12-months, with adjusted adherence of 4.8±0.3, 3.5±0.03, and 2.6±0.03 hours/night in the Coaching-365, Coaching-90, and Coaching-0 groups, respectively, over days 270-365. Conclusion Remote behavior change coaching over 12-months is associated with significantly increased CPAP adherence. Although usage declined in all groups, the rate of decline was not as steep in patients undergoing coaching for a full year, compared to those who stop coaching at day-90 or those who began CPAP without coaching. Our data suggest that phone-based behavior change coaching could represent an efficient, scalable solution to increase CPAP adherence. Support (If Any) Philips Respironics.