0915 Comparison of In-person Versus Telehealth Positive Airway Pressure Set Up for Rural Veterans

Abstract

Abstract Introduction Traditionally, positive airway pressure (PAP) therapy is initiated in a face-to-face visit. This can be a barrier to accessing care for rural Veterans. The COVID-19 pandemic led to the implementation of telehealth PAP set-ups at two large VA sleep centers providing an opportunity to assess the effectiveness of telehealth versus face-to-face PAP initiation in rural Veterans. Methods We performed a retrospective cohort study of rural Veterans (defined by the Rural-Urban Commuting Areas system) to compare outcomes for those who initiated PAP with in-person visits prior to the COVID-19 pandemic to those who initiated PAP with telehealth during the COVID-19 pandemic. We assessed the days of PAP use, hours of PAP use and residual Apnea Hypopnea Index (AHI) at 30-day and 90-day intervals in these two groups. We excluded individuals who received a replacement device, and those who received PAP on or after June 14, 2021, due to a safety recall of PAP devices that may have affected use. Results PAP initiation data was available for 93 individuals, approximately half of whom were initiated on PAP in-person (n=46) and half by telehealth (n=47). There were no significant differences between the in-person and telehealth groups in terms of age, BMI, and AHI, which were 57.23±16 vs 60.67±14 (mean±SD), 31.81±5 vs 31.99±13, and 27.52±23/hr vs 28.85±22/hr respectively. The average number of days per month with PAP use at 30-day and 90-day intervals for in-person vs telehealth set-up was 17.59±11 vs 15.38±12 (p=0.36) and 15.54±13 vs 14.11±14 (p=0.60) respectively. The average number of hours of PAP use at 30-days and 90-days for in-person vs telehealth set-up was 3.25±3 vs 3.11±3 (p=0.82) and 3.15±3 vs 3.07±3 (p=0.90) respectively. The residual AHI at 30-days and 90-days for in-person vs telehealth set-up was 6.61±8/hr vs 5.25±6/hr (p=0.37) and 6.35±8/hr vs 7.68±11/hr (p=0.60) Conclusion In this cohort of rural Veterans, there were no significant differences in outcomes for those who initiated PAP therapy via telehealth when compared to in-person. This supports the feasibility of more widespread implementation of telehealth services for treatment of OSA in order to improve access without compromising patient outcomes. Support (if any) VA OCC FY21 RFA, VAGLAHS GRECC, K24HL143055