Telemedicine home CPAP titration and follow-up in the COVID-19 scenario

Jaume Bordas-Martinez; Neus Salord; Eva Fontanilles; Eliseo Prado; María Calvo; João Carmezim; Salud Santos; Carmen Monasterio

doi:10.1183/23120541.00084-2022

Telemedicine home CPAP titration and follow-up in the COVID-19 scenario

ERJ Open Res. 2022 Oct 24;8(4):00084-2022. doi: 10.1183/23120541.00084-2022. eCollection 2022 Oct.

Authors

Jaume Bordas-Martinez¹, Neus Salord¹, Eva Fontanilles¹, Eliseo Prado¹, María Calvo¹, João Carmezim², Salud Santos¹, Carmen Monasterio¹

Affiliations

¹ Respiratory Department, Bellvitge University Hospital, Institut Investigacions Biomèdiques de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain.
² Biostatistics Unit, IDIBELL, Barcelona, Spain.

Abstract

Introduction: Continuous positive airway pressure (CPAP) titration was dramatically affected by the coronavirus disease 2019 (COVID-19) pandemic due to increased biological risk. This study aimed to compare successful CPAP adaptation and compliance with home telemedicine CPAP titration with the usual method based on face-to-face visits.

Methodology: A prospective cohort using telemedicine home CPAP titration and follow-up during the COVID-19 pandemic (TC) was compared with a retrospective cohort receiving face-to-face pre-pandemic home titration (RC). The TC included a subgroup with a smartphone application (TC-APP). Successful CPAP adaptation and compliance at 1 month of follow-up were the main endpoints, while patient satisfaction and costs were secondary endpoints.

Results: 210 consecutive patients were evaluated (80 RC and 130 TC). 36 patients were in the TC-APP subgroup. CPAP titration was successful in 90% in RC versus 95% in TC and 100% in TC-APP. No compliance differences between groups were found at 1 month (4.79 h·night^-1 RC, 4.33 h·night^-1 TC and 4.59 h·night^-1 TC-APP). Mean±sd patient satisfaction out of 10 was 7.69±2.05 in RC versus 9.02±0.64 in TC (p<0.001). 64% of the TC-APP subgroup reported that their telemedicine strategy influenced an increase in CPAP use (p=0.011). CPAP adaptation with follow-up had an estimated direct staff cost per patient of EUR 19.61±8.61 in TC with no smartphone application used versus EUR 23.79±9.94 in TC-APP (p=0.048).

Conclusions: Telemedicine in CPAP titration and early follow-up is equivalent to the usual care in terms of successful adaptation and compliance, while achieving greater patient satisfaction.