Francesca M Nicosia1,2, Bhavika Kaul3,4, Annette M Totten5, Molly C Silvestrini6, Katherine Williams3,4, Mary A Whooley3,4, Kathleen F Sarmiento3,4. 1. San Francisco VA Medical Center, 4150 Clement Street, 151-R, San Francisco, CA, 94121, USA. Francesca.nicosia@ucsf.edu. 2. University of California, San Francisco, San Francisco, USA. Francesca.nicosia@ucsf.edu. 3. San Francisco VA Medical Center, 4150 Clement Street, 151-R, San Francisco, CA, 94121, USA. 4. University of California, San Francisco, San Francisco, USA. 5. Oregon Health & Science University, Portland, USA. 6. VA Puget Sound Health Care System, Seattle, USA.
Abstract
BACKGROUND: Obstructive sleep apnea is common among rural Veterans, however, access to diagnostic sleep testing, sleep specialists, and treatment devices is limited. To improve access to sleep care, the Veterans Health Administration (VA) implemented a national sleep telemedicine program. The TeleSleep program components included: 1) virtual clinical encounters; 2) home sleep apnea testing; and 3) web application for Veterans and providers to remotely monitor symptoms, sleep quality and use of positive airway pressure (PAP) therapy. This study aimed to identify factors impacting Veteran's participation, satisfaction and experience with the TeleSleep program as part of a quality improvement initiative. METHODS: Semi-structured interview questions elicited patient perspectives and preferences regarding accessing and engaging with TeleSleep care. Rapid qualitative and matrix analysis methods for health services research were used to organize and describe the qualitative data. RESULTS: Thirty Veterans with obstructive sleep apnea (OSA) recruited from 6 VA telehealth "hubs" participated in interviews. Veterans reported positive experiences with sleep telemedicine, including improvements in sleep quality, other health conditions, and quality of life. Access to care improved as a result of decreased travel burden and ability of both clinicians and Veterans to remotely monitor and track personal sleep data. Overall experiences with telehealth technology were positive. Veterans indicated a strong preference for VA over non-VA community-based sleep care. Patient recommendations for change included improving scheduling, continuity and timeliness of communication, and the equipment refill process. CONCLUSIONS: The VA TeleSleep program improved patient experiences across multiple aspects of care including a reduction in travel burden, increased access to clinicians and remote monitoring, and patient-reported health and quality of life outcomes, though some communication and continuity challenges remain. Implementing telehealth services may also improve the experiences of patients served by other subspecialties or healthcare systems.
BACKGROUND: Obstructive sleep apnea is common among rural Veterans, however, access to diagnostic sleep testing, sleep specialists, and treatment devices is limited. To improve access to sleep care, the Veterans Health Administration (VA) implemented a national sleep telemedicine program. The TeleSleep program components included: 1) virtual clinical encounters; 2) home sleep apnea testing; and 3) web application for Veterans and providers to remotely monitor symptoms, sleep quality and use of positive airway pressure (PAP) therapy. This study aimed to identify factors impacting Veteran's participation, satisfaction and experience with the TeleSleep program as part of a quality improvement initiative. METHODS: Semi-structured interview questions elicited patient perspectives and preferences regarding accessing and engaging with TeleSleep care. Rapid qualitative and matrix analysis methods for health services research were used to organize and describe the qualitative data. RESULTS: Thirty Veterans with obstructive sleep apnea (OSA) recruited from 6 VA telehealth "hubs" participated in interviews. Veterans reported positive experiences with sleep telemedicine, including improvements in sleep quality, other health conditions, and quality of life. Access to care improved as a result of decreased travel burden and ability of both clinicians and Veterans to remotely monitor and track personal sleep data. Overall experiences with telehealth technology were positive. Veterans indicated a strong preference for VA over non-VA community-based sleep care. Patient recommendations for change included improving scheduling, continuity and timeliness of communication, and the equipment refill process. CONCLUSIONS: The VA TeleSleep program improved patient experiences across multiple aspects of care including a reduction in travel burden, increased access to clinicians and remote monitoring, and patient-reported health and quality of life outcomes, though some communication and continuity challenges remain. Implementing telehealth services may also improve the experiences of patients served by other subspecialties or healthcare systems.
Authors: Kathleen F Sarmiento; Robert L Folmer; Carl J Stepnowsky; Mary A Whooley; Eilis A Boudreau; Samuel T Kuna; Charles W Atwood; Connor J Smith; W Claibe Yarbrough Journal: J Clin Sleep Med Date: 2019-09-15 Impact factor: 4.062
Authors: Christopher J Koenig; Traci Abraham; Kara A Zamora; Coleen Hill; P Adam Kelly; Madeline Uddo; Michelle Hamilton; Jeffrey M Pyne; Karen H Seal Journal: J Rural Health Date: 2016-08-10 Impact factor: 4.333
Authors: Frances M Weaver; Alex Hickok; Bharati Prasad; Elizabeth Tarlov; Qiuying Zhang; Amanda Taylor; Brian Bartle; Howard Gordon; Rebecca Young; Kathleen Sarmiento; Denise M Hynes Journal: J Gen Intern Med Date: 2020-04-02 Impact factor: 6.473
Authors: Lucas M Donovan; Ashley C Mog; Kelly N Blanchard; Kate H Magid; Adnan S Syed; Lynette R Kelley; Brian N Palen; Elizabeth C Parsons; Catherine C McCall; William Thompson; Matthew Charlton; Laura J Spece; Susan Kirsh; David H Au; George G Sayre Journal: J Clin Sleep Med Date: 2021-08-01 Impact factor: 4.324