Meet the team
Consultant in Respiratory and General Medicine, Wessex QI Fellowship Alumn
Portsmouth Hospitals NHS Trust
- England - Wessex
- Claudia Maldonado - Senior Sleep Technologist
What is the challenge your project is going to address and how does it connect to your chosen theme?
Despite improvements in technology, CPAP compliance is fair at best; and patients may require numerous appointments until adequate compliance is met. This blocks many outpatient appointments. Furthermore, an early appointment after CPAP initiation can help patients to achieve a better compliance, which is desirable but early appointments are scant due to an increased demand on the sleep service. Telemedicine (TM) enables us to monitor CPAP therapy remotely including CPAP usage; treatment efficiency; mask leak; and treatment pressures, which can also be modified remotely. Compliant patients could be contacted by telephone to enquire about treatment efficacy thus eliminating the need for further appointments. We envisage that patients can be monitored more efficiently using TM compared to traditional outpatient appointments and would like to explore if this is acceptable, if not preferable to our patient cohort.
What does your project aim to achieve?
We aim to devise a TM algorithm that enhances CPAP therapy by providing early behavioural or technical support in an attempt to defer compliant patients; and improve treatment outcomes in patients that achieve suboptimal compliance. Our work will deliver evidence based data comparing a TM protocol to traditional outpatient appointments. We aim to quantify the patients that can be fast tracked for a maintenance review, saving an appointment. TM allows treatment titration in some patients to improve compliance, which is a benefit to patients, and reduces the need for short term follow ups. Furthermore, non compliant patients could be identified early; and an early decision could be made about discontinuing therapy, which may limit missed appointments. Ultimately, we aim to streamline the current sleep service protocols in order to cope with increasing demand. Freeing up outpatient appointments will allow healthcare professionals to focus on patients that need to be seen.
How will the project be delivered?
The project will be delivered by the sleep team with QI methodological oversight by EL. The sleep service at Portsmouth Hospital NHS Trust is well established. Our specialist nurses and physiologists conduct regular outpatient appointments, they are experts in their field and also help patients over the telephone; and use remote technology to obtain treatment information to improve the patient experience, and treatment efficiency. We have over 3000 patients on maintenance reviews, and schedule up to 20 CPAP set up appointments weekly. All of our patients have access to walk-in clinics that we hold twice per week. Any patient that requires face to face contact is encouraged to attend a walk-in clinic, including patients in our cohort. The number of walk-in clinics attended will need to be factored into our calculations; as well as the time required to remotely examine treatment data and telephone patients if an intervention is required.
What and how is your project going to share learning throughout?
This project forms part of a postgraduate degree. We hope to share our results with interested parties through regular reports, including the Q community stakeholders, the NHS, and the University of Portsmouth. Ultimately this information will be used to aid decision makers about our sleep service treatment protocols. We also hope that this research will be passed onto the scientific community through peer reviewed journal publications. Current research in this topic is conflicting, and mostly focused on American and European populations operating in different health care systems to the NHS. Our work will help to integrate up to date research into a clinical practice to improve treatment outcomes and work productivity, and contribute to the general pool of knowledge in this growing field.