056 CPAP TREATMENT UNDER THE JAPANESE MEDICAL CARE SYSTEM

Abstract

Purpose: Since Japan is one of the few countries where the whole population is covered by mandatory health insurance, all CPAP machines and expendable supplies are covered at the same price on a monthly basis with the condition that CPAP users also make a clinic-visit once per month. The aim of this study was to determine the level of compliance of our patients with obstructive sleep apnea syndrome (OSAS) with this system and to discover the reasons for non-compliance as well as the demographics of the non-compliant individuals. The OSAS patient cohort in this study included 268 patients (244 males and 24 females, mean age 54.1±13.4 years) who were supposed to attend monthly CPAP check-ups with a physician consultation over the 5-month period fromMay 1 to September 30, 2008. Methods: The progress notes of the subjectswere examined to identify those patients who attended the CPAP clinic less than five times and to investigate the reasons for their non-adherence to the program. Results: A total of 32 patients (11.3%, 30 males and 2 females, mean age 50.1±11.2 years) did not atttend the clinic for all five of the required visits. The provided reasons were classified into five groups: A) patients whose first visit to the general neurological clinic involved a reason other than sleepiness or insomnia (14 patients), B) patients who failed to come only for one particular occasion (5 patients), C) patients whose prior visits had been very regular and then suddenly stopped coming to the clinic (4 patients), D) patients who had not been well-informed with respect to the CPAP treatment program set-up by the insurance system (3 patients), and E) other reasons (6 patients). Conclusion: Most of our patients were adherent to the mandatory monthly CPAP follow-up. Asymptomatic patients who did not realize the direct benefit of CPAP were less adherent. Therefore it was indicated that patient selection may be an important factor for continuing treatment. A further comparison between the characteristics of the adherent and non-adherent patients is warranted.