Assessment, referral and management of obstructive sleep apnea by Australian general practitioners: a qualitative analysis

Nicole Grivell,Richard Reed,Andrew Vakulin,Jenny Haycock,Anne Redman,Elizabeth Hoon,Nigel Stocks,Oliver Frank,Ronald R Grunstein,Nicholas Zwar,Ching Li Chai-Coetzer,R Doug Mcevoy

doi:10.1186/s12913-021-07274-7

Abstract

BackgroundThe high and increasing demand for obstructive sleep apnea (OSA) care has exceeded the capacity of specialist sleep services prompting consideration of whether general practitioners could have an enhanced role in service delivery. However, little is known about the current involvement, experiences and attitudes of Australian general practitioners towards OSA. The purpose of this study was to provide an in-depth analysis of Australian general practitioners’ experiences and opinions regarding their care of patients with OSA to inform the design and implementation of new general practice models of care.MethodsPurposive sampling was used to recruit participants with maximum variation in age, experience and location. Semi-structured interviews were conducted and were analysed using Thematic Analysis.ResultsThree major themes were identified: (1) General practitioners are important in recognising symptoms of OSA and facilitating a diagnosis by others; (2) Inequities in access to the assessment and management of OSA; and (3) General practitioners currently have a limited role in the management of OSA.ConclusionsWhen consulting with patients with symptoms of OSA, general practitioners see their primary responsibility as providing a referral for diagnosis by others. General practitioners working with patients in areas of greater need, such as rural/remote areas and those of socio-economic disadvantage, demonstrated interest in being more involved in OSA management. Inequities in access to assessment and management are potential drivers for change in future models of care for OSA in general practice.

Highlights

The high and increasing demand for obstructive sleep apnea (OSA) care has exceeded the capacity of specialist sleep services prompting consideration of whether general practitioners could have an enhanced role in service delivery
Theme 1: General practitioner (GP) are important in recognising symptoms of OSA and facilitating a diagnosis by others This first theme relates to patient assessment and referral practices, and highlights the role of GPs in supporting patients to gain an OSA diagnosis from sleep services beyond primary care
Whilst some GPs noted that patients may raise the issue of sleep and tiredness, there was widespread agreement that initial assessment for OSA was primarily initiated by GPs

Summary

Introduction

The high and increasing demand for obstructive sleep apnea (OSA) care has exceeded the capacity of specialist sleep services prompting consideration of whether general practitioners could have an enhanced role in service delivery. Obstructive sleep apnea (OSA), a condition characterised by repeated obstruction of the upper airway during sleep, is associated with hypertension, reduced quality of life, increased incidence of motor vehicle accidents and stroke [1,2,3,4]. It is a highly prevalent condition, with an estimated 50% of men and 23% of women aged 40 years or over living with moderate-to-severe sleepdisordered breathing [5]. Several randomised controlled trials have recently demonstrated that primary care management of OSA is not inferior to specialist-led care, which leads the way for a more primary care focused approach to OSA management [16,17,18,19]

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