PennPALS Automated Text Messaging System Helps Identify Risk of Nonadherence to PAP Therapy


After 30 days of the PennPALS system, 70.8% of the remaining 24 patients were adherent to treatment or were using their PAP machine for at least 4 hours/night on average over the last 7 days.

David Jimenez

David Jimenez

In new analysis, the Penn PAP Automated Learning System (PennPALS), an automated, bidirectional text messaging system, effectively identified/intervened with patients at risk of nonadherence to positive airway pressure (PAP) therapy and improved adherence rates within the first 30 days of treatment.1

When used appropriately, PAP treatment is highly effective in normalizing breathing and sleep, improving symptoms, and lowering adverse event risk; however, patients do not necessarily accept, tolerate, or comply with treatment. In this analysis, presented at the 2022 SLEEP Annual Meeting, June 4-8, in Charlotte, North Carolina, lead investigator David Jimenez, MD student, University of Pennsylvania School of Medicine, and colleagues aimed to see if PennPALS could increase patient adherence to PAP therapy.

PennPALS was developed by researchers at the University of Pennsylvania and created using Way to Health, an evidence-based patient engagement platform. Through this, investigators leveraged PAP data, such as daily average hours of use and time spent with a large mask leak, to identify and initiative automated text messages for patients who may need it. Depending on their responses, patients were given a predefined recommendation via text or escalated to a clinical provider who contacted them via phone call.

The analysis included two 30-day pilot studies that enrolled 33 individuals, mostly White (54.8%), who were prescribed PAP for the first time. PennPALS engaged patients via text message 115 times. After excluding 2 individuals who did not receive a PAP machine by the end of the trial, 22.6% of the sample were adherent from the start of enrollment and only received positive enforcement text messages. Of the remaining cohort (77.4%) that experienced issues, there were 58 text message conversations, which resulted in 32 clinical escalations.

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In total, 32.3% (n = 10) of the cohort had triggered text messaging interventions for using PAP for less than 4 hours/night on average over a 7-day period and 35.5% (n = 11) had triggered texts for experiencing a large mask leak. At 30 days, 70.8% (n = 17) of the 24 patients were adherent to treatment, defined as using PAP for at least 4 hours/night on average over the last 7 days. Patient feedback was generally favorable, with a Net Promoter Score of 68.4 (n = 19).

The PennPALS system had been previously studied before, most notably in patients who underwent orthopedic or urologic procedures. In this cohort study of 41 patients discharged from 2 urban emergency departments (ED), 88% reported acquiring naloxone, a medication used to prevent opioid overdose, or a naloxone prescription from the ED. Overall, 66% planned to continue carrying naloxone, including most patients who were not carrying the drug before their ED visits.2

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1. Jimenez D, Cadman S, Watach A, Khan N, Hahn L, Bae C. PennPALS: an innovative, bidirectional text messaging system using PAP usage data to increase patient adherence with PAP therapy. Presented at: SLEEP Annual Meeting, 2022; June 4-8; Charlotte, NC. Abstract 0361
2. Agarwal AK, Sangha HK, Spadaro A, et al. Assessment of patient-reported naloxone acquisition and carrying with an automated text messaging system after emergency department discharge in Philadelphia. JAMA Netw Open. 2022;5(3):e223986. doi:10.1001/jamanetworkopen.2022.3986
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