Each night millions of patients use continuous positive airway pressure (CPAP) devices to manage their sleep apnea and other chronic conditions. While CPAP is considered the gold standard treatment for sleep apnea, many patients still struggle with consistent adherence, explained Amy Cook, director of Healthcare Informatics for ResMed, at the MD&M West 2017 conference. Despite advances in device comfort and ease of use, CPAP adherence rates still hover around 50 percent.
Patients stop using therapy for a variety of reasons: the mask may be uncomfortable or ill-fitting, they cannot relax enough to adjust to the pressure, or they simply aren't motivated or supported, explained Cook. In her talk, "Mission Impossible--Making a CPAP that Users Won't Abandon," Cook detailed ResMed's plan to improve device use and encourage compliance. The solution not only involved a new design--it meant empowering patients with data to deepen engagement. Use-case testing played key roles in device development.
Cook said it was important for ResMed to first understand the problems behind patient noncompliance. The company could then brainstorm solutions, develop design prototypes for testing, refine those designs, and repeat the process--several times, if needed.
ResMed's product innovations were the result of extensive product testing. To address patient concerns about mask comfort and fit, ResMed changed its dual-wall design, which had been the standard for more than 25 years, to its new Infinity Seal technology. To address pressure concerns, the company introduced its AutoRamp feature, which delivers a lower pressure until patients fall asleep. The system then automatically and comfortably ramps up the pressure to the prescribed level.
Features to ease comfort and fit were tested by patients. "Use-case testing creates an opportunity for us to understand where patients are facing challenges and provides fixes before a product reaches the marketplace," explained Cook. "By involving first-time users with no previous product experience or education," ResMed was able to document patient behavior in multiple scenarios, such as turning on and cleaning the device, putting on the mask, and more. Such observations enabled ResMed to "understand and document patient workflows and identify patient pain points," she said.
The AirFit 20 series masks with the new Infinity Seal cushion, for instance, may have been tested more than any other mask, Cook presented. More than 500 patients were fitted around the world in international fitting studies, "a first for ResMed," she said.
To encourage patient compliance, ResMed also built wireless communications into its AirSense 10 and AirCurve 10 devices starting in 2014. The devices transmit data on patient use to ResMed's AirView, enabling providers to access salient information about patient use to help them better understand and more efficiently work with patients on their therapy experience, Cook said. Patients are scored on usage hours, mask seal, and more, and they can access their scores each morning through ResMed's web- and iOS-based myAir patient engagement platform.
"We turn that data into value for patients," Cook said. "We build in coaching and reinforcement for patients, and we coach in little bites. It's based on cognitive behavior change techniques."
To date, more than 2 million patients and more than 1 billion nights of sleep have been monitored and documented through ResMed's connected care ecosystem, Cook said. Through such patient engagement, as well as provider monitoring and intervention, ResMed has seen dramatic increases to patient adherence. In one study of 128,000 patients, more than 87 percent of PAP users were compliant on therapy when using myAir and monitored by the provider-facing AirView, compared to 70 percent compliance for those monitored by AirView alone, representing a 24 percent relative increase when patient engaged is added.
There's also value for healthcare providers, as a Remote Assist function can detect whether a patient's device is working properly and allows providers to remotely troubleshoot and adjust therapy settings as necessary. There's also quick access to compliance documentation. And according to one study, healthcare labor costs dropped 59 percent, Cook said.
ResMed's goal is to change 20 million lives by 2020, through improving patients' quality of lives, slowing chronic disease progression, and reducing healthcare system costs.
For perspectives on medical device development, plan to attend the conference at Advanced Design & Manufacturing Cleveland March 29-30. You'll learn about the journey from product conceptualization to market entry as well as the emerging technologies that are changing the future of the healthcare landscape.
Featured image is a slide from Cook's MD&M presentation used courtesy of ResMed.
Daphne Allen is executive editor of Pharmaceutical & Medical Packaging News and a contributor to Qmed. Reach her at firstname.lastname@example.org and on Twitter at @daphneallen