title: Telehealth services to improve nonadherence: A placebo-controlled study.
abstract: The objective of this study was to test whether a telehealth intervention could improve the compliance with continuous positive airway pressure (CPAP) by patients with sleep apnea. These patients had been nonadherent for the initial 3 months of therapy even after receiving the initial standard and then supplemental audiotaped/videotaped patient education for adhering to CPAP nightly. The materials and methods included a randomized testing of experimental and placebo interventions. Interventions were delivered by nurses to two groups in their homes by telehealth over a 12-week period. The placebo intervention was used to control for Hawthorne effect, time and attention influences and the novelty of having telehealth in the home. Results following the telehealth interventions were that significantly more patients in the experimental group 1 (n = 10) than the placebo group 2 (n = 9) were adhering nightly to CPAP (chi 2 = 4.55, p = 0.033). Group 1 patients reported greater satisfaction with their intervention. However, both groups rated telehealth delivery positively. The mean cost of each 20-minute telehealth visit was 30 dollars while the total cost of the telehealth intervention for each patient was 420 dollars. These costs included telehealth equipment, initial installation, longdistance telephone charges, nurse salary, and intervention materials. Conclusions are that telehealth interventions are a potentially cost-effective service for increasing adherence to prescribed medical treatments. Replication studies with large samples and in other clinical groups are recommended.
authors.affiliation: School of Nursing, University of Kansas, Kansas City, Kansas 66160-7502, USA. csmith@kumc.edu
authors.forename: Carol E
authors.initials: CE
authors.lastname: Smith
authors.forename: Emily R
authors.initials: ER
authors.lastname: Dauz
authors.forename: Faye
authors.initials: F
authors.lastname: Clements
authors.forename: Florence N
authors.initials: FN
authors.lastname: Puno
authors.forename: David
authors.initials: D
authors.lastname: Cook
authors.forename: Gary
authors.initials: G
authors.lastname: Doolittle
authors.forename: William
authors.initials: W
authors.lastname: Leeds
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020181:Sleep Apnea, Obstructive / Q000191:economics / Q000628:therapy*; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D016312:Treatment Refusal