eISSN: 2449-8580
ISSN: 1734-3402
Family Medicine & Primary Care Review
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2/2021
vol. 23
 
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abstract:

Adherence to home ventilation therapy in patients with Obstructive Sleep Apnea Syndrome: prevalence, determinants and costs of non-compliance. A cross-sectional study

Mariana Martins
1
,
Rafaela Passos
2
,
Joana Peixoto
3
,
Christelle Costa
4
,
Luís Mendes
5
,
Paulo Santos
6, 7
,
Rui Nêveda
8

1.
USF Uarcos, Alto Minho Local Health Unit, Viana do Castelo, Portugal
2.
USF Gil Eanes, Alto Minho Local Health Unit, Viana do Castelo, Portugal
3.
USF Mais Saúde, Alto Minho Local Health Unit, Viana do Castelo, Portugal
4.
USF Arquis Nova, Alto Minho Local Health Unit, Viana do Castelo, Portugal
5.
USF Baião, ACES Tâmega I, Baião, Portugal
6.
Faculty of Medicine, University of Porto, Portugal
7.
CINTESIS – Center for Health Technology and Services Research, University of Porto, Portugal
8.
Pulmonology Department, Alto Minho Local Health Unit, Viana do Castelo, Portugal
Fam Med Prim Care Rev 2021; 23(2): 185–189
Online publish date: 2021/07/06
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Introduction
Obstructive sleep apnea (OSA) is a common chronic disease with high impact both as an independent cardiovascular risk factor and in quality of life. Home positive pressure ventilation is the main available therapeutic intervention, depending on its utilization by patients.Our aim was to determine the adherence to home ventilation therapy, prospecting for the determinants of compliance. Secondarily, we evaluated the direct costs of non-adherence.

Material and methods
We conducted a cross-sectional study based on retrospective analysis of a sample of 1,183 OSA patients followed in a pulmonology department during 2018. Patients with less than 180 days of utilization were excluded. The adherence to ventilation therapy was defined by utilization of more than 4 hours a day, at least 70% of the days. Costs were calculated using Portuguese official prices for reimbursement.

Results
A total of 744 patients were included for analysis. The adherents were 63.4% (95% CI: 60.5–67.4%). Ageing (p = 0.014), severity of disease at diagnosis (p = 0.044), room sharing (p = 0.002), working in the primary economic sector (p = 0.014) and using BiPAP (p = 0.046) were associated with higher adherence. The total costs of non-adherence were estimated at 112,373.68 €.

Conclusions
The adherence of patients to treatments is a relevant topic of discussion. Our results are concordant with literature, reinforcing the importance of holding the patient accountable to improve compliance with treatment. Adherence is lower than necessary to achieve the maximization of the therapeutic benefits, leading to a higher burden of disease, higher costs and significant waste.

keywords:

obstructive sleep apnea, noninvasive ventilation, continuous positive airway pressure, treatment adherence and compliance, health care costs

 
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