Presentations

Abstract

Introduction:

Oral appliance therapy (OAT) is emerging as a popular alternative to CPAP, the gold standard for obstructive sleep apnea (OSA) treatment. However, CPAP machines are often poorly tolerated and thus have lower compliance rates. OAT is found by many patients to be less cumbersome, leading to improved compliance. Unlike CPAP and other traditional treatment methods employed by sleep physicians, OAT is often custom-fit and managed by dentists. The availability, efficacy and ease of access of OAT is an ongoing subject of research both nationally and internationally. This project seeks to elucidate the accessibility of OAT as a viable alternative for the treatment of OSA as it pertains to patients and providers in the Hampton Roads, Virginia area.

Methods:

The "secret shopper" methodology, in which study investigators pose as patients calling dental practices, was used to garner information regarding the availability and cost of OAT, insurance coverage, and prior referral requirements, among other factors. A call script probing these factors was piloted with three randomly chosen dental practices from a spreadsheet containing all general dental practices in Hampton Roads before being finalized. For each city in Hampton Roads (Chesapeake, Norfolk, Hampton, Portsmouth, Suffolk, Newport News, and Virginia Beach), 50% of practices listed on the spreadsheet were randomly selected to contact. A survey was created in the data entry and analysis service, REDCap, to operationalize and aggregate the information from secret shopper calls.

Results:

Of 97 practices in the Hampton Roads area contacted, 43 (44.3%) offered OAT. Of these practices, 21 (53.8%) required a referral from a sleep physician. For the practices that shared the estimated cost of OAT (n=25), the average cost was $1628; lowest price of $470, and highest of $3000. Most practices report little to no coverage from either medical or dental insurance; 16 practices stated outright they accept no form of insurance for OAT. Only 19 practices were able to provide a referral to a local provider who does offer OAT; this included a combination of general dentists, cosmetic/implant dentists, periodontists, orthodontists, and oral/maxillofacial surgeons.

Conclusions:

Just over half of dental practices surveyed in the Hampton Roads area did not offer OAT. Of those that did, there were variable requirements on prior referrals and proof of diagnosis. Most practices required an initial consultation/impression with a dentist. Overall, insurance coverage was limited and highly variable. Further investigation on insurance coverage, out of pocket costs and referral patterns in OAT is warranted to identify larger trends nationally, target common barriers to OAT, and improve outcomes in patients with OSA.