AUTHOR=Daabek Najeh , Tamisier Renaud , Foote Alison , Revil Hélèna , Joyeux-Jaure Marie , Pépin Jean-Louis , Bailly Sébastien , Borel Jean-Christian 

TITLE=Impact of Healthcare Non-Take-Up on Adherence to Long-Term Positive Airway Pressure Therapy

JOURNAL=Frontiers in Public Health

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.713313

DOI=10.3389/fpubh.2021.713313

ISSN=2296-2565

ABSTRACT=<p><bold>Background:</bold> The effectiveness of positive airway pressure therapies (PAP) is contingent on treatment adherence. We hypothesized that forgoing healthcare may be a determinant of adherence to PAP therapy.</p><p><bold>Research Question:</bold> The objectives were: (i) to assess the impact of forgoing healthcare on adherence to PAP in patients with Chronic Respiratory Failure (CRF) and patients with Obstructive Sleep Apnea Syndrome (OSAS); (ii) to compare forgoing healthcare patterns in these two chronic conditions.</p><p><bold>Study design and methods:</bold> Prospective cohort of patients with OSAS or CRF, treated with PAP therapies at home for at least 12 months. At inclusion, patients were asked to fill-in questionnaires investigating (i) healthcare forgone, (ii) deprivation (EPICES score), (iii) socio-professional and familial status. Characteristics at inclusion were extracted from medical records. PAP adherence was collected from the device's built-in time counters. Multivariable logistic regression models were used to assess the associations between healthcare forgone and the risk of being non-adherent to CPAP treatment.</p><p><bold>Results:</bold> Among 298 patients included (294 analyzed); 33.7% reported forgoing healthcare. Deprivation (EPICES score &gt; 30) was independently associated with the risk of non-adherence (OR = 3.57, 95%CI [1.12; 11.37]). Forgoing healthcare had an additional effect on the risk of non-adherence among deprived patients (OR = 7.74, 95%CI [2.59; 23.12]). OSAS patients mainly forwent healthcare for financial reasons (49% vs. 12.5% in CRF group), whereas CRF patients forwent healthcare due to lack of mobility (25%, vs. 5.9 % in OSAS group).</p><p><bold>Interpretation:</bold> Forgoing healthcare contributes to the risk of PAP non-adherence particularly among deprived patients. Measures tailored to tackle forgoing healthcare may improve the overall quality of care in PAP therapies.</p><p><bold>Clinical Trial Registration:</bold> The study protocol was registered in <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT03591250" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, identifier: NCT03591250.</p>