Annual review of patients with sleep apnea/hypopnea syndrome - a pragmatic randomised trial of nurse home visit versus consultant clinic review


Palmer, S; Selvaraj, S; Dunn, C; Osman, LM; Cairns, J; Franklin, D; Hulks, G; Godden, DJ; (2004) Annual review of patients with sleep apnea/hypopnea syndrome - a pragmatic randomised trial of nurse home visit versus consultant clinic review. Sleep medicine, 5 (1). pp. 61-65. ISSN 1389-9457 DOI: https://doi.org/10.1016/S1389-9457(03)00166-7

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Abstract

Background: This pragmatic randomised, controlled trial investigated annual review of patients with sleep apnea/hypopnea syndrome (SAHS). Clinical outcomes and costs were compared for consultant clinic review versus specialist nurse home visit. Method: One hundred and seventy-four patients were 7randomised to annual review by consultant clinic appointment or by specialist nurse home visit. SAHS symptoms. Epworth score, hospital anxiety and depression scale (HADS), Short Form-36 (SF-36) and hours of use of constant positive airway pressure (CPAP) were measured before and 3 months after review. The costs and patient preference for review were determined. Results: After review, both groups significantly increased CPAP use (mean (SD) increase: nurse, 0.66 (1.71) h; consultant, 0.45 (1.69) h) and reduced symptom scores (nurse, - 2 (7); consultant, - 3 (9)), compared to baseline. There were no differences between groups in these improvements, or in HADS or SF-36 scores. Average duration of a nurse home visit, excluding travel time, was 26 (6) min. Total NHS cost per visit was pound52.26 (49.85) ($83.62 (79.76)), of which pound6.57 (1.43) ($10.51 (2.29)) reflected time spent with the patient and the remainder was travel cost. Average duration of consultant review was 10 (6) min, total NHS cost pound6.21 (3.99) ($9.94 (6.38)). However, the cost to the patient of attending the clinic was pound23.63 (23.21) ($37.81 (37.13)). Patient preference for review was nurse 16%, consultant 19%, and no preference 65%. Conclusion: Following annual review, use of CPAP increased and symptoms improved. Outcomes were similar for consultant and nurse led review. Home visits were expensive for the healthcare provider, whereas clinic attendance incurred substantial costs to the patient. The majority of patients would accept nurse review for their sleep apnea management. (C) 2003 Elsevier B.V. All rights reserved.

Item Type: Article
Keywords: sleep apnea syndrome, CPAP, quality of life, symptoms, economics, outpatient review, apnea, scale, Annual Reports, Female, Home Nursing, economics, statistics & numerical data, House Calls, economics, statistics & numerical data, Human, Male, Middle Aged, Outcome Assessment (Health Care), Positive-Pressure Respiration, economics, methods, Questionnaires, Sleep Apnea Syndromes, diagnosis, economics, epidemiology, therapy, Support, Non-U.S. Gov't, Utilization Review
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 14725828
Web of Science ID: 189355100010
URI: http://researchonline.lshtm.ac.uk/id/eprint/14505

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