While APAP devices are generally categorized as low-risk devices by the Food and Drug Administration, their performance in an individual patient may depend on how they are set, where they are set-up, how patients are selected and instructed, and how patients on such therapy are monitored (45). The concern is that physicians in busy practices may be unable to keep up with the changes in technology.
Unlike pharmaceutical products, physicians do not receive information regarding post-approval trials, nor do they receive education by a cadre of pharmaceutical representatives. In a 2004 survey of board-certified sleep physicians, only 30% of physicians correctly identified the contra-indications for administration of APAP devices (36).
Moreover, thirty percent of sleep physicians never prescribed APAP devices. Physicians who never prescribe APAP devices tended to interpret fewer sleep studies and tended to prescribe fewer PAP devices per month than physicians who prescribed APAP devices suggesting that patient volumes were indicative of physician confidence in prescribing such devices (36).
Moreover, 90% of physicians who prescribed auto-PAP devices reported that they reviewed the data downloaded from the device for pressure, leak, and adherence information. The time spent in interpreting the downloads for leak, appropriate pressure level, and troubleshooting during care delivery in an ambulatory APAP program are, however, not reimbursed for physician time. Future policy changes to reimbursement should consider provider compensation to such care delivery if APAP is envisioned to be embraced by providers.