Patient experience of postal CPAP in COVID era: A unique mode of CPAP trials

ABSTRACT

Background: The COVID19 pandemic stopped most face to face (F2F) interventions like CPAP & NIV as they were deemed aerosol generating (AGP) and only telephone consultations continued. Prior to this we were performing 30 CPAP trials/week. We realised that without an alternative our patients will have to wait a long time for treatment. Methods: We sent CPAP machines by post with MirageFX nasal mask, a sizing gauge for full face mask along with a link to a Youtube video that we created simulating F2F trial. Patients received a phone call prior to sending the kit explaining what to expect & address any concerns. A pre-setup Airsense 10 machine with our standard CPAP booklet was sent and remote monitoring was enabled for a 4 week virtual review. We assessed patients' experience with this system and whether this could become the new normal. A survey questionnaire was sent to all patients. Most responses were on a 5 point Likert scale, 0 being very poor & 5 excellent. Results: We sent 171 CPAPs(ESS 12±5,ODI 32±22) between 27th April & 17th July 2020. 85(50%) responded to the (Table presented) survey. 95% felt able to set up the device successfully. 80% felt better or much better. Overall satisfaction score was 9/10 on a 10 point scale. 75% accessed the video. Table 1 shows the results. Conclusion: 95% patients could setup their devices through remote instructions without any F2F interaction. Initial phone call from the clinical team helped to address queries reducing future interactions. This new way of CPAP trial shows excellent patient satisfaction & less than half needed additional support. Most patients felt symptomatically better, suggesting good response to CPAP. Moving routine trials from F2F to postal had a significant impact in reducing waiting list, room utilizations, AGPs, PPE & man power usage. This reduced hospital visits during pandemic & allowed us to focus on more vulnerable patients. Currently we are sending 30 postal CPAPs/wk. If we have a second spike all F2F interactions might stop again hence we propose this as the standard practice limiting F2F CPAPs only in situations when this is not possible.