title: Diagnostic pathways for obstructive sleep apnoea in the Australian community: observations from pharmacy-based CPAP providers.
abstract: OBJECTIVE
  Models for the diagnosis of obstructive sleep apnoea (OSA) are evolving in many countries to meet public demand. In Australia, the unregulated sleep industry does not provide a framework to govern or review emerging pathways in the community. The objectives of this study were to (1) describe current diagnostic pathways for OSA in Australia as reported by continuous positive airway pressure (CPAP) providers in community pharmacies and (2) obtain stakeholder feedback on pathways and identify potential areas for practice improvement.
  
  
  METHODS
  Semi-structured telephone interviews were conducted with pharmacy-based CPAP practitioners. Participants described diagnostic pathways used in their setting. Subsequently, an expert forum of stakeholders provided feedback on identified pathways during a focus group.
  
  
  RESULTS
  Twenty-two telephone interviews were conducted, identifying six key diagnostic pathways. Pathways varied in terms of the diagnostic test used, the practitioner who initiated or interpreted the test and who discussed results with the patient and made treatment recommendations. A nine-member stakeholder group raised medical, ethical and organisational concerns over certain pathways. Concerns included diagnostic tests initiated or interpreted in the absence of an appropriately trained medical practitioner and potential conflicts of interest for CPAP providers offering both diagnostic and treatment services. A best practice framework was proposed to guide practice and translate study findings. Preliminary practice recommendations were subsequently developed.
  
  
  CONCLUSIONS
  Diagnostic models have evolved in Australia that raise stakeholder concerns. It is important to address these concerns while still facilitating patient access to services. Development of a practice framework could promote medically appropriate, patient-centred care.
authors: Faculty of Pharmacy, The University of Sydney, Pharmacy Building A15, Science Road, Sydney, NSW, 2006, Australia. carissa.hanes@sydney.edu.au.|NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia. carissa.hanes@sydney.edu.au.
authors: Carissa A
authors: CA
authors: Hanes
authors: NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.|Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.|Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.
authors: Keith K H
authors: KK
authors: Wong
authors: Faculty of Pharmacy, The University of Sydney, Pharmacy Building A15, Science Road, Sydney, NSW, 2006, Australia.|NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.
authors: Bandana
authors: B
authors: Saini
mesh_terms: D003157:Community Pharmacy Services; D045422:Continuous Positive Airway Pressure; D019091:Critical Pathways; D003431:Cross-Cultural Comparison; D003695:Delivery of Health Care; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D009517:New South Wales; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy*
keywords: Continuous positive airway pressure; Diagnostic techniques and procedures; Obstructive sleep apnoea; Pharmacies; Polysomnography; Primary care