Does Weekly Telephone Contact Enhance the Compliance of Home Apnea Monitoring? † 1299

Abstract

Objective:To evaluate the efficacy of weekly telephonic contact with families in enhancing the use of home apnea monitoring.Methods: This was a prospective randomized single blinded study of 38 infants who were prescribed home apnea monitoring for the following indications 1.Apnea of prematurity (92%)2.Other pulmonary, cardiac or neurologic problems(8%). Exclusion criteria included 1.No home telephone 2.Participation in any other study involving home monitoring. Infants were assigned to a 'standard care' or 'Weekly telephone call' group by a stratified balanced block technique. All families were given the following instructions for monitor use: 1.During the first 4 week period the monitor was to be used at night and unattended times (appox 95%); 2.During the second 4 week period the monitor was to be used at night and unattended times (appox 60%). The families in the telephone group were contacted weekly for 8 weeks. The telephone contact reviewed the events of the previous week but did not include specific encouragement to use the monitor to avoid the Hawthorne effect. Both groups received routine Pediatric care and follow up at high risk premature clinic. Our primary outcome measure was compliance which was defined as the percentage of time the infant spent on the monitor as recorded by the event monitoring. Results:The Telephone (n=18) and Standard care (n=20) groups were similar (p>.40) with respect to birth weight (1647 +/- 856 vs 1509 +/- 678gms), gestational age (31.4 +/- 4.3 vs 29.8 +/- 4.0wks); maternal age (24.1 +/- 5.4 vs 25.3 +/- 5.7yr) and commercial insurance (44% vs 40%), a marker of higher socioeconomic status. Compliance of the telephone verses the standard care group was similar (70.0 +/- 21.3 vs 70.2 +/- 24.6%; p=.715, MannWhitney U):1st 4 week period (76.9 +/- 21 vs 81.4 +/- 25.5, p=.143); 2nd 4 week period (54.9 +/- 32 vs 61.1 +/- 29, p=.564). The only factor which improved compliance was rehospitalisation (88.0 +/- 15.6% vs 75.8 +/- 24.8%; p=.037) Conclusions:Weekly telephone contact, without specific encouragement to use the monitor, did not improve compliance. Compliance was greater in subjects who were rehospitalised regardless of their telephone/standard care group status. We speculate that in this already compliant population, more targeted advice is necessary to further improve compliance.