TY - JOUR
T1 - Assessment, referral and management of obstructive sleep apnea by Australian general practitioners: a qualitative analysis
AU - Grivell, Nicole
AU - Haycock, Jenny
AU - Redman, Anne
AU - Vakulin, Andrew
AU - Zwar, Nicholas
AU - Stocks, Nigel
AU - Frank, Oliver
AU - Reed, Richard
AU - Chai-Coetzer, Ching Li
AU - Grunstein, Ronald R.
AU - McEvoy, R. Doug
AU - Hoon, Elizabeth
N1 - Funding Information:
Australian GPs work almost exclusively within privately-owned practices within the context of a predominantly publicly funded health care system. Activity within general practice is primarily funded by the Medicare Benefits Schedule (MBS), the funding scheme provided by the Australian Government to subsidise medical services, and within the MBS there are funding streams for comprehensive assessment and management of chronic diseases (of at least six months duration). Recently there have been changes to the MBS funding for OSA in Australia. In response to a rise in referrals for polysomnography (PSG), GPs are now required to assess individuals that they suspect of having OSA prior to patient referral for an MBS subsidised PSG: specifically, GPs must determine a patient’s likelihood of having OSA (using one of the assessment tools: STOP-BANG, OSA-50, Berlin Questionnaire) [–], which is symptomatic (using the Epworth Sleepiness Scale) [, ]. To access a PSG, Australians can refer themselves to commercial sleep services or they can be referred to private sleep physicians or public outpatient services (often with long wait times). Some commercial sleep services offer PSG with no out-of-pocket expense with the option to purchase a CPAP device following diagnosis []. Whilst CPAP can be funded by patients or private insurers, publicly funded CPAP therapy in Australia is restricted to those on government welfare benefits, and access is inconsistent across the states and territories of Australia [].
Funding Information:
Applicable to all authors, this research has been supported by competitive research funding from the National Health and Medical Research Council of Australia and research funding and equipment from the ResMed Foundation grant and Philip Respironics Clinical Research grant.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/11/18
Y1 - 2021/11/18
N2 - Background: The high and increasing demand for obstructive sleep apnea (OSA) care has exceeded the capacity of specialist sleep services prompting consideration of whether general practitioners could have an enhanced role in service delivery. However, little is known about the current involvement, experiences and attitudes of Australian general practitioners towards OSA. The purpose of this study was to provide an in-depth analysis of Australian general practitioners’ experiences and opinions regarding their care of patients with OSA to inform the design and implementation of new general practice models of care. Methods: Purposive sampling was used to recruit participants with maximum variation in age, experience and location. Semi-structured interviews were conducted and were analysed using Thematic Analysis. Results: Three major themes were identified: (1) General practitioners are important in recognising symptoms of OSA and facilitating a diagnosis by others; (2) Inequities in access to the assessment and management of OSA; and (3) General practitioners currently have a limited role in the management of OSA. Conclusions: When consulting with patients with symptoms of OSA, general practitioners see their primary responsibility as providing a referral for diagnosis by others. General practitioners working with patients in areas of greater need, such as rural/remote areas and those of socio-economic disadvantage, demonstrated interest in being more involved in OSA management. Inequities in access to assessment and management are potential drivers for change in future models of care for OSA in general practice.
AB - Background: The high and increasing demand for obstructive sleep apnea (OSA) care has exceeded the capacity of specialist sleep services prompting consideration of whether general practitioners could have an enhanced role in service delivery. However, little is known about the current involvement, experiences and attitudes of Australian general practitioners towards OSA. The purpose of this study was to provide an in-depth analysis of Australian general practitioners’ experiences and opinions regarding their care of patients with OSA to inform the design and implementation of new general practice models of care. Methods: Purposive sampling was used to recruit participants with maximum variation in age, experience and location. Semi-structured interviews were conducted and were analysed using Thematic Analysis. Results: Three major themes were identified: (1) General practitioners are important in recognising symptoms of OSA and facilitating a diagnosis by others; (2) Inequities in access to the assessment and management of OSA; and (3) General practitioners currently have a limited role in the management of OSA. Conclusions: When consulting with patients with symptoms of OSA, general practitioners see their primary responsibility as providing a referral for diagnosis by others. General practitioners working with patients in areas of greater need, such as rural/remote areas and those of socio-economic disadvantage, demonstrated interest in being more involved in OSA management. Inequities in access to assessment and management are potential drivers for change in future models of care for OSA in general practice.
UR - http://www.scopus.com/inward/record.url?scp=85119414904&partnerID=8YFLogxK
U2 - 10.1186/s12913-021-07274-7
DO - 10.1186/s12913-021-07274-7
M3 - Article
C2 - 34794444
AN - SCOPUS:85119414904
VL - 21
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 1248
ER -
