Human touch boosts patient compliance

By helping to inject the "human element" into the treatment of patients with sleep disordered breathing, providers can tremendously impact how successful the market ultimately becomes, say industry watchers. That human element includes actively promoting the value of CPAPs to physicians, educating the public on the seriousness of obstructive sleep apnea and diligently following up with patients to ensure compliance with their therapies. Bryan Hansel, CEO of Adel, Iowa-based Evo Medical believes that while technology has made some impressive gains in the CPAP area over the past few years, it may have reached a point of diminishing fiscal returns. The enhanced functionality of CPAP units may have the potential to increase compliance, but in Hansel's view, more attention must be paid to low-tech measures, such as promoting apnea awareness and more fastidious patient intervention. "We have found that product features don't matter as much as the educational and human elements of managing patients," he said. "We have tremendous equipment, but as a company we're not investing in the next breakthrough widget because the core therapy isn't the problem. Awareness and patient adoption of the therapy is." The crux of the issue, adds Invacare's Bob Messenger, is determining how much value features like exhalation unloading and gradual pressure ramping provide versus the extra cost they add to the product. This comparison is especially important in the context of competitive bidding, he said. "With competitive bidding looming, it makes you wonder if it will cause some of the bells and whistles to go away," said Messenger, product manager for the Elyria, Ohio-based manufacturer's sleep division. "At some point, Medicare's decisions affect other payers. If competitive bidding defines reimbursement, providers will have to look at what they pay for these devices." Market potential 'huge' Despite competitive bidding's possible downward pressure on reimbursement, those serving the sleep market are enthused about its chances for growth. Although CPAP technology has been around since the 1980s, sleep science is still a new medical frontier. Researchers are still just beginning to understand the complexities of sleep apnea, such as nocturnal hypoventilation, and obesity hypoventilation as well as upper airway resistance syndrome, observes Mick Farrell, vice president of marketing for Poway, Calif.-based ResMed. "The market as a whole is still largely under-penetrated," he said. "We are currently treating just 10% of the 40 million Americans with sleep-disordered breathing. Even with the obstructive sleep apnea segment accounting for more than half of the SDB sufferers, we have a long way to go to get positive airway pressure to the patients who need it. So the market is huge and our potential as HME providers and manufacturers to serve this under-met medical need is still great." Raising the awareness level among physicians and the public about sleep apnea and its consequences is an ongoing challenge for manufacturers and providers alike, says Gretchen Jezerc, director of U.S. marketing for sleep-disordered breathing at Murrysville, Pa.-based Respironics. Still, there are signs that promotional efforts are working, she said. "We're driving a 'call to action' for physicians to get involved in identifying potential sleep apnea patients and recommending that they get it diagnosed," Jezerc said. "Our 'Sleep Well, Be Healthy' campaign with ResMed has had a major impact. We are also leveraging the Super Bowl project that involved apnea screening of NFL players this year. That has really gotten people's attention." A pharmaceutical ad blitz for insomnia and restless leg syndrome has also produced a spillover effect for the rest of the industry because the messages emphasize the importance of sleep, she said. Key to compliance Industry studies show OSA patient adherence to sleep therapy programs remaining static at around 50% despite advancements in technology. Tom Moulton, president of Hampton, N.H.-based SleepNet attributes it to a chronic discomfort with CPAP masks. "The primary reason that most patients do not comply with the therapy is because their masks are uncomfortable due to it being old technology," he said. "Don't get me wrong, in recent years driver technology has made great strides, regarding quietness, humidification, compactness, portability and better breathing assistance features. These are all good things and positive attributes that patients will like, but if they do not use the therapy because the mask is uncomfortable, you are still nowhere. "Most patients have to wear a mask six, seven, eight hours a night and certainly the mask is a very personal product," he continued. "If more attention was paid to patient comfort, compliance would be higher, business would be better and patients would be happier. Until a higher level of patient comfort is attained, compliance will continue to be in the toilet."