The effectiveness of a community pharmacist-led intervention to improve screening for sleep apnea in primary care – A cohort study

Abstract

Despite the high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. In many developed countries, because community pharmacists (CP) are easily accessible, they have been developing additional clinical services that integrate the services of and collaborate with other healthcare providers (general practitioners (GPs), nurses, etc.). Alternative strategies for primary care screening programs for OSAS involving the CP are discussed. We aimed to determine whether the involvement of a CP in the care pathway of a patient at risk for OSAS, through the implementation of a GP-CP collaborative intervention, was effective that is to say if it improved the detection rate and diagnosis of the disease in this population. Setting: 31 community pharmacies in 5 regions in France. Participants: Patients at risk for OSAS, i.e taking 1 or more anti- hypertensive drugs, being overweight (BMI > 25), snoring nearly every night. Intervention: The CP intervention consisted in (i) a discussion with the patient on the risks and comorbidities associated with untreated OSAS, (ii) guiding the patient to fill in the Berlin Questionnaire and the Epworth Sleepiness Scale and (iii) encouraging the patient to consult his/her referent GP with the questionnaires results and urging the doctor, in a letter written to his/her intention, to continue investigations. Measurement: Proportion of patients who had performed a diagnostic test for OSAS. 782 Patients were analysed (88 patients exposed and 694 patients unexposed). After a 6 months follow-up, the number of patients who had performed a diagnostic test for OSAS was significantly higher in the exposed group compared to the unexposed group (22.7% versus 11.4%, p = 0.003). Being exposed to the CP intervention was associated with a higher chance of having a diagnostic test for OSAS, (adjusted OR: 2.34 [1.26–4.35]). These findings provide arguments for the implementation of a CP-GP collaborative OSAS screening intervention in community pharmacy routine practice. Future research should focus on potential economic benefits of such an intervention. We would like to thank the Ordre National des Pharmaciens and all the community pharmacists who participated in this study for their support in this new adventure.