The Importance of Patient Compliance with CPAP
By James R. Criasia, MA, RRT
Much confusion arises when compliance with CPAP use is discussed in the medical literature. First, let’s try to determine the meaning of the phrase “patient compliance to CPAP use.” If we interpret this as a patient who wears his CPAP at the prescribed pressure during sleeping hours, seven nights a week, then we have a starting point to measure compliance.
Meslier et al. looked at 3,225 patients in a French study and found a self-reported compliance of 80 percent after six months, with an average use of 6 hours, 36 minutes +/- 2 hours, 15 min. The patient base of this study had only minimal patient education and follow-up.
Teran et al. looked at 88 patients on CPAP for 29 +/- 11 months and found a compliance rate of 70 percent as measured by time counters in the CPAP equipment. They noted that subjective evaluations of compliance by patients overestimated the actual use of the CPAP device. This study also had only minimal patient education and follow-up.
Alarcon et al. looked at 124 patients and found a compliance rate of 60 percent, while a Krieger study found compliance rates varying from 77 to 89 percent, depending on the definitions used for compliance.
But if physicians who order CPAP therapy for their patients were to conclude that compliance to therapy is routinely as low as the current literature reports it to be, they would be grossly misled. Indeed, most studies that do not consider patient education and follow-up home visits by qualified respiratory therapists all show similar compliance percentages.
Our CPAP program, which currently has about 1,000 patients in it, uses a combination of patient education and a follow-up process, allowing us to demonstrate compliance rates ranging from about 75 to nearly 100 percent. We have monitored the progress of all our patients over the past three years, using various methods to collect data.
As part of our program, we monitor patient compliance with a questionnaire administered by a respiratory therapist in the patient’s home.
Our current study shows that compliance is about 95 percent for all our patients during the first year, when therapists visit as often as every three months and follow-up phone calls are made.
During the first year, we provide follow-up services to all our patients, regardless of their insurance coverage.
After the first year, however, compliance levels drop to about 75 percent in years two to three for those patients whose insurance does not allow for regular therapist visits.
Patients who continue to get therapist visits every three to six months maintain their compliance at high levels. Their rates remain at approximately 95 percent in years two and three. Clearly, regularly scheduled visits by a respiratory therapist do make a difference.
There are many factors involved in patient compliance to physician-prescribed CPAP. However, our studies here show patient education and follow-up home visits are extremely influential factors.
Until more insurance providers allow for this type of follow-up and care, we will probably continue to see a continuation of the poor compliance rates generally cited in medical literature.
James R. Criasia is the director of Respiratory Care Services at Home Health Corporation of America, Canton, Mass.
Available upon request.