Authors (including presenting author) :
LI CML(1), WONG LF(1), TO WC(1), YUEN YC(1), WONG HK(1), KWOK WMM(2), NG SW(3) & CHOY CFF(1)
Affiliation :
(1) Respiratory Specialty, Department of Medicine, Tseung Kwan O Hospital (2) Nursing Service Division, Tseung Kwan O Hospital (3) Nursing Service Division, United Christian Hospital
Introduction :
With the emergence of COVID-19 pandemic, concerns have been raised about patient impacts on the restricted access to primary health care regarding chronic disease monitoring while physical distancing directive is on. In view of enhancing patient benefits and responding to the health and social challenge, telehealth has been incorporated into the workflow of clinical practice and was first piloted in Respiratory Nurse Clinic (Sleep-related breathing disorders) since November 2020.
Objectives :
1. To develop an alternative modality of service delivery 2. To ensure promising treatment effect and safety with telehealth 3. To explore the patients’ attitudes towards telehealth
Methodology :
This program was aimed to develop telehealth and evaluate its efficacy in maintaining CPAP compliance after patients transition from conventional Sleep Apnea Nurse Clinic (usual care in SACN) to telehealth. Key components included workflow development, patient identification in HA GO, health assessment, acquisition of e-compliance report & patient empowerment. Subjects were (1) aged > 18 years old with regular follow-ups in SACN and acquired satisfactory skills in CPAP application; (2) able to use telehealth devices or assisted by others; (3) able to consent in a clear and understandable manner; (4) located in HK & (5) stable physical condition and examination not critical. Repeated measures of paired sample t-test were employed. Outcome measures were (1) CPAP compliance, (2) mask leakage, (3) residual Apnea Hypopnea Index (AHI), (4) Epworth Sleepiness Scale (ESS), (5) CPAP compliance at 6 months after telehealth & (6) patient satisfaction survey.
Result & Outcome :
From November 2020 to November 2022, 44 patients (with 94 attendances) were recruited and 93.2% were male. It revealed comparable results in telehealth to usual care in terms of compliance rate (72.71±33.41 vs 71.23±33.55, p=0.67), mask leakage (37.61±32.09 vs 35.11±31.9, p=0.09), ESS (6.3±5.29 vs 6.52±4.91, p=0.53) and residual AHI (2.5±3.04 vs 2.49±2.36, p=0.96) respectively. At the 6-month telehealth follow-up, it also revealed similar results to initial telehealth in compliance rate (73.5±29.14 vs 72.71±3.41, p=0.8), mask leakage (37.42±31.81 vs 37.61±32.09, p=0.88), and residual AHI (2.91±3.99 vs 2.5±3.04 to, p=0.37) respectively, except ESS showed statistically significant improvement (5.79±5 vs 6.3±5.29), p=0.027. Satisfaction survey scored very high, with majority of patients (76.9%) expressed an attitude favorable towards telehealth, average score 9.13 out of 10, SD=0.95. To conclude, Telehealth in our Sleep Apnea Nurse Clinic has been proven its implementation without compromising compliance, efficacy, acceptance, patient satisfaction and healthcare cost compared to the conventional face-to-face model. Telehealth would be well accepted by participants who need to stay longer time at home and require social distancing during the COVID-19 pandemic.
