Primary care and sleep unit agreement in management decisions for sleep apnea: a prospective study in Spain
Por:
Penacoba, P, Llauger, MA, Fortuna, AM, Flor, X, Sampol, G, Pijoan, AMP, Grau, N, Santiveri, C, Juvanteny, J, Aoiz, JI, Bayo, J, Lloberes, P, Mayos, M
Publicada:
15 sep 2020
Resumen:
Study Objectives: Involvement of primary care teams in the care of patients with OSA is a focus of interest. The study objective was to compare diagnostic and therapeutic agreement between decisions taken by primary care professionals and sleep unit specialists.
Methods: This was a prospective multicenter study conducted at primary care and specialized care centers in the urban area of Barcelona, Spain. Men and women aged 18-75 years who visited the participating primary care centers for any reason were recruited. Both primary care physicians and sleep specialists made a diagnostic and therapeutic decision with clinical data and results of a home sleep apnea test. All patients were finally assessed with respiratory polygraphy or polysomnography as a gold-standard test.
Results: A total of 229 patients underwent a home sleep apnea test and were evaluated at the primary care centers and the sleep units. Diagnostic agreement using the same tools and excluding indeterminate decisions was 69.8% (Cohen's kappa = 0.64; 95% confidence interval, 0.56-0.72). Agreement for therapeutic decisions (PAP vs conservative treatment) was obtained in 82.5% of patients (Cohen's kappa = 0.62; 95% confidence interval, 0.51-0.73), increasing to 92.5% (Cohen's kappa = 0.49, 95% confidence interval, 0.40-0.58) when indeterminate options were excluded. As compared with the final therapeutic decisions made at the sleep unit with respiratory polygraphy/polysomnography, primary care physicians agreed regarding 83.3% (Cohen's kappa = 0.62; 95% confidence interval, 0.49-0.74) of patients.
Conclusions: Primary care professionals may assume an important role in the management of OSA in coordination with sleep centers, identifying patients who require specific treatment and should be referred to specialized care.
Filiaciones:
Penacoba, P:
Univ Autonoma Barcelona, Dept Resp Dis, Sleep Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Llauger, MA:
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Inst Catala Salut, Ctr Atencio Primaria CAP Maragall, Equip Atencio Primaria Encants, Barcelona, Spain
Fortuna, AM:
Univ Autonoma Barcelona, Dept Resp Dis, Sleep Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Flor, X:
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Inst Catala Salut, CAP Chafarinas, Barcelona, Spain
Sampol, G:
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Serv Pneumol, Sleep Unit, Barcelona, Spain
Inst Invest Carlos III, Ctr Invest Biomed Red Enfermedades Resp, Madrid, Spain
Pijoan, AMP:
Consorci Sanitari Integral, Area Basica Salut Gaudi, Barcelona, Spain
Grau, N:
Inst Invest Carlos III, Ctr Invest Biomed Red Enfermedades Resp, Madrid, Spain
Hosp Mar, Dept Resp Med, Sleep Unit, Parc Salut Mar IMIM, Barcelona, Spain
Santiveri, C:
Hosp Maig, Serv Pneumol, Consorci Sanitari Integral, Barcelona, Spain
Juvanteny, J:
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Inst Catala Salut, CAP Trinitat Vella, Barcelona, Spain
Aoiz, JI:
Inst Catala Salut, CAP El Clot, Barcelona, Spain
Bayo, J:
Inst Catala Salut, CAP El Clot, Barcelona, Spain
Lloberes, P:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Serv Pneumol, Sleep Unit, Barcelona, Spain
Inst Invest Carlos III, Ctr Invest Biomed Red Enfermedades Resp, Madrid, Spain
Mayos, M:
Univ Autonoma Barcelona, Dept Resp Dis, Sleep Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Inst Invest Carlos III, Ctr Invest Biomed Red Enfermedades Resp, Madrid, Spain
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