1192 ADAPTATION OF A BRIEF MOTIVATIONAL ENHANCEMENT EDUCATION PROGRAM DURING CPAP INITIATION TO AN ACADEMIC PUBLIC SLEEP CLINIC

Abstract

A brief motivational enhancement education program (BMEEP) developed in Hong Kong is a pragmatic intervention that may improve CPAP adherence (Lai, CHEST 2014). We adapted BMEEP to a Los Angeles County public sleep clinic (BMEEP-LA) and evaluated implementation and effectiveness. Our hypotheses: 1) Patient and staff acceptance of BMEEP-LA would be high; 2) Patients who received BMEEP-LA would achieve greater CPAP adherence compared to usual care. BMEEP-LA was adapted to accommodate staffing, appointment availability, workflow and language/cultural factors, while maintaining core features of video education, motivation interviewing and negative message framing. BMEEP-LA encounters were provided by a Sleep NP-specialist trained in motivational interviewing. During 3/15/2016 - 7/15/2016, 78 newly-diagnosed patients completed BMEEP-LA. Acceptance was evaluated qualitatively by semi-structured patient and staff interviews. Electronic CPAP adherence data at 1 and 3 months were collected and compared to: 1) a case-matched control group that received usual care during 1/1/2014 - 12/31/2015 (informal education during CPAP set-up); and 2) published data from the BMEEP trial. Comparisons among groups were tested by student’s t-test and binomial approximation. The BMEEP-LA and control groups were equivalent by age, gender, racial/ethnic, BMI, Epworth score, subjective sleepiness and AHI. Compared to the BMEEP trial, BMEEP-LA had similar age and AHI ranges, but lower proportion of men (50% vs 84%), dissimilar racial/ethnic composition (70% Hispanics/0% Chinese vs 100% Chinese) and higher mean BMI (37.4 vs 28.6). Interviews with patients and staff indicated high acceptance of BMEEP-LA. Adherence indicators were similar to the BMEEP trial at 1 and 3 months. Compared to controls, BMEEP-LA adherence indicators were similar at 1 month, but higher at 3 months (82 +/- 23% vs 66 +/- 33% days used (p=0.003), 4hr 47min vs 3 hr 36 min daily use (p=0.003), 63 +/- 23 vs 49 +/- 33% days with >4 hr use (p=0.016), and 36 vs 23% patients with >70% days of >4hr use (p=0.072)). Despite having been developed for Chinese patients, BMEEP was successfully adopted in a Los Angeles County sleep clinic with disparate demographic/social-cultural characteristics and engendered long-term CPAP adherence improvement over usual care. none