title: Veteran Preferences Regarding Wireless Management of Positive Airway Pressure for Obstructive Sleep Apnea at a Tertiary Health-Care System.
abstract: BACKGROUND
  Timely monitoring of obstructive sleep apnea (OSA) therapy can be a challenge amid conflicting pressures of rising patient volume and shortage of sleep medicine providers. Positive airway pressure (PAP) devices with wireless modem technology have the potential to improve patient access to care and streamline work load, yet little is known about patient attitudes toward telehealth integration among veterans with sleep apnea. As part of a larger quality improvement initiative at the Veterans Affairs (VA) Puget Sound Health Care System, we elicited veterans' preferences toward modem versus traditional PAP data download, including patient attitudes and factors affecting those preferences.
  
  
  METHODS
  We conducted an anonymous survey of veterans without previous CPAP experience presenting for initial device setup and training at VA Puget Sound PAP clinics. Surveys assessed subject demographics, PAP download preferences (modem vs mail), and Likert-type scale ratings of importance placed on factors including convenience and information privacy. Using multinomial logistic regression, we examined the association between convenience rating and download preference, adjusting for information privacy rating, age, and commute time.
  
  
  RESULTS
  Of 444 surveys analyzed, respondents were primarily male with a mean age of 52 y. Most respondents reported taking ≥ 30 min to commute to the PAP clinic. Convenience was rated as the most important factor affecting download preferences. Veteran preferences regarding PAP download method were mixed, with 47% preferring modem, 38% preferring memory card mail-in, and 15% undecided. A higher rating of convenience was significantly associated with modem preference, both before and after adjustment for information privacy rating, commute time, and veteran age (adjusted relative risk ratio 1.67,P< .001, 95% CI 1.40-1.99).
  
  
  CONCLUSIONS
  PAP data download preferences were mixed among new veteran users. Veterans placed a high value on the potentially competing concerns of convenience and information privacy. Veterans preferring modem factored convenience as important in their decision making, independent of privacy concerns.
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Ken
authors.initials: K
authors.lastname: He
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington.|Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Brian N
authors.initials: BN
authors.lastname: Palen
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mattox
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington. Elizabeth.parsons@va.gov.|Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Parsons
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000379:methods / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D020181:Sleep Apnea, Obstructive / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods; D013686:Telemetry / Q000379:methods / Q000523:psychology*; D062606:Tertiary Care Centers; D014481:United States; D014728:Veterans / Q000523:psychology*
keywords: CPAP; e-health; home health monitoring; patient preference; sleep apnea syndrome; technology; telehealth; telemedicine