Project Summary
Fragmentation of care can lead to poor treatment adherence in patients with chronic medical conditions which can, in turn, lead to adverse health consequences, poor quality of life, and patient dissatisfaction. Poor treatment adherence may be due to lack of sufficient patient education, time delays in delivery of care, lack of adequate healthcare coordination, or difficulty accessing various healthcare providers across a front desk that serves as a "healthcare bottle-neck." Better efficiency in healthcare delivery, with greater connectivity through knowledgeable and trained peer volunteers and cheap cell phones integrated by a smart telephone exchange, may alleviate some of the care and communication burden faced by the healthcare system.
Specifically, such community health education volunteers ("peer-buddies") who are experienced in managing their disease condition may be able to impart knowledge and confidence to a recently diagnosed patient in a much more personalized manner than that of a group therapy session. An additional important advantage is the peer-buddy's ability to relate to the patient in a manner consistent with their social, ethnic, and cultural beliefs without language barriers or differences that may stem from socioeconomic strata.
We will use sleep apnea as an example condition to test the effect of a peer-buddy helper (combined with the universal availability of personal cell phones) on the problem of poor care coordination and treatment adherence to the "CPAP" treatment for sleep apnea. Sleep apnea is a very common condition that affects 7-12% of the US population and, if left untreated, can lead to poor health and even death through its effects on high blood pressure, heart disease, stroke, and motor vehicle accidents. Fortunately, CPAP therapy can lead to a three-fold reduction in such consequences, but patient adherence to such CPAP treatment is generally poor.
We have recently completed a small study that demonstrated improved usage of CPAP treatment by patients receiving help from a peer-buddy with excellent results. We propose to further enhance the "peer-buddy" community-volunteer concept in our proposed research by combining this with cell-phone technology and a telephone exchange that improves access to healthcare providers, technicians, and home care companies. We hope to show that active community participation by experienced "lay individuals" assisted by the universal availability of cheap cell phones can improve the reach and effectiveness of our healthcare system in improving the health and well-being of our patients. If successful, such an innovative and community-based approach can be applied to other chronic medical conditions.
Vasquez MM, McClure LA, Sherrill DL, Patel SR, Krishnan J, Guerra S, Parthasarathy S. Positive Airway Pressure Therapies and Hospitalization in Chronic Obstructive Pulmonary Disease. Am J Med. 2017 Jan 12. pii: S0002-9343(17)30010-4. doi: 10.1016/j.amjmed.2016.11.045. [Epub ahead of print] PubMed PMID: 28089799.
Combs D, Goodwin JL, Quan SF, Morgan WJ, Shetty S, Parthasarathy S. Insomnia, Health-Related Quality of Life and Health Outcomes in Children: A Seven Year Longitudinal Cohort. Sci Rep. 2016 Jun 13;6:27921. doi: 10.1038/srep27921. PubMed PMID: 27295263; PubMed Central PMCID: PMC4904740.
Mosier JM, Hypes C, Joshi R, Whitmore S, Parthasarathy S, Cairns CB. Ventilator Strategies and Rescue Therapies for Management of Acute Respiratory Failure in the Emergency Department. Ann Emerg Med. 2015 Nov;66(5):529-41. doi: 10.1016/j.annemergmed.2015.04.030. Epub 2015 May 23. Review. PubMed PMID: 26014437.
Combs D, Goodwin JL, Quan SF, Morgan WJ, Parthasarathy S. Modified STOP-Bang Tool for Stratifying Obstructive Sleep Apnea Risk in Adolescent Children. PLoS One. 2015 Nov 18;10(11):e0142242. doi: 10.1371/journal.pone.0142242. eCollection 2015. PubMed PMID: 26581088; PubMed Central PMCID: PMC4651349.
Parthasarathy S, Shetty S, Combs D. Mend the Mind and Mind the "MCC". Sleep. 2015 Jul 1;38(7):1001-3. doi: 10.5665/sleep.4794. PubMed PMID: 26085292; PubMed Central PMCID: PMC4481002.
Combs D, Goodwin JL, Quan SF, Morgan WJ, Parthasarathy S. Longitudinal differences in sleep duration in Hispanic and Caucasian children. Sleep Med. 2015 Jun 29. pii: S1389-9457(15)00825-4. doi: 10.1016/j.sleep.2015.06.008. [Epub ahead of print] PubMed PMID: 26299467; PubMed Central PMCID: PMC4548806. (Abstract only available)
Shetty S, Parthasarathy S. Obesity Hypoventilation Syndrome. Curr Pulmonol Rep. 2015 Mar 1;4(1):42-55. PubMed PMID: 26029497; PubMed Central PMCID: PMC4444067. (Abstract only available)
Flygare J, Parthasarathy S. Narcolepsy: let the patient's voice awaken us! Am J Med. 2015 Jan;128(1):10-3. doi: 10.1016/j.amjmed.2014.05.037. Epub 2014 Jun 12. PubMed PMID: 24931392; PubMed Central PMCID: PMC4264987.
Clinical Research Study: A Meta-analysis of Sleep-promoting Interventions During Critical Illness (Abstract only available)
C. Poongkunran, S.G. John, A.S. Kannan, S. Shetty, C. Bime, S. Parthasarathy. “Clinical Research Study: A Meta-analysis of Sleep-promoting Interventions During Critical Illness.” The American Journal of Medicine. (January 2015)
Combs D, Shetty S, Parthasarathy S. Advances in Positive Airway Pressure Treatment Modalities for Hypoventilation Syndromes. Sleep Med Clin. 2014 Sep;9(3):315-325. PubMed PMID: 25346650; PubMed Central PMCID: PMC4205540.
For Healthier Nights and Longer Lives - A narrative on this project, with a look at how experienced patients help those newly diagnosed with sleep apnea learn to use a challenging but effective treatment.
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