{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T06:04:18Z","timestamp":1780380258828,"version":"3.54.1"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Obstructive sleep apnea (OSA), a disorder caused by repeated collapse of the upper airway resulting in pauses in breathing, is highly prevalent among United States (US) Veterans. Prior to the COVID pandemic, telehealth for clinical appointments and diagnostic testing for OSA was used within the U.S. Department of Veterans Affairs (VA); however, experience was limited with telehealth for initiation of PAP (Positive Airway Pressure), mailing the device to the Veteran, and educating on use through a phone or video visit. Limited literature is available evaluating patients\u2019 experience with this \u201ctele-PAP\u201d setup. The aim of this study is to understand the experiences of Veterans with OSA with Tele-PAP or face-to-face PAP setup (\u201cFTF-PAP\u201d) in the US using qualitative methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted semi-structured phone interviews with a convenience sample of 40 Veterans. Interviews included six domains: delivery of PAP device, knowledge of OSA, equipment setup process, challenges using the device, preferred setup modality, and suggestions for improvement. Four investigators coded transcripts using qualitative analysis software. Themes were identified through iterative discussion and consensus. Each transcript was independently coded by at least two coders, and illustrative quotes were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty Veterans with an even mix of PAP initiation modalities (Tele-PAP; FTF-PAP) were interviewed. While both delivery and training modalities were generally well received, we identified several patient factors associated with a preference for one modality over the other. These included patients\u2019 preferred learning style, the cost of traveling to the clinic, preexisting otolaryngological problems, and concurrent psychological factors such as post-traumatic stress disorder (PTSD) and claustrophobia. Regardless of modality, many Veterans had trouble recalling who to contact for troubleshooting or refills.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Based on Veteran interviews, tele-PAP initiation to treat OSA improved accessibility to sleep medicine and reduced costs for Veterans. Successful PAP therapy initiation depends on several factors that should be identified early in the PAP initiation process to enable selection of the optimal mode of care (Tele-PAP vs. FTF-PAP). Our qualitative data, while limited in number and focused on the Veteran population, document patients\u2019 acceptance of tele-PAP and illustrate that the approach is a viable alternative to F2F-PAP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2026.1760059","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:40:55Z","timestamp":1780378855000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Lessons learned from a qualitative evaluation of Veterans\u2019 experience with the VA tele-PAP program during the COVID pandemic"],"prefix":"10.3389","volume":"6","author":[{"given":"Kyu Seo","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Informatics, Clinical Epidemiology and Translational Data Science, Oregon Health & Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritchie","family":"Verma","sequence":"additional","affiliation":[{"name":"Division of Informatics, Clinical Epidemiology and Translational Data Science, Oregon Health & Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Medicine, San Francisco VA Healthcare System","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette M.","family":"Totten","sequence":"additional","affiliation":[{"name":"Division of Informatics, Clinical Epidemiology and Translational Data Science, Oregon Health & Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Malcolm","sequence":"additional","affiliation":[{"name":"San Francisco VA Healthcare System","place":["San Francisco, CA, United States"]},{"name":"Division of Pulmonary, Critical Care, Sleep Medicine, & Allergy, University of California","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Kennedy","sequence":"additional","affiliation":[{"name":"San Francisco VA Healthcare System","place":["San Francisco, CA, United States"]},{"name":"Division of Pulmonary, Critical Care, Sleep Medicine, & Allergy, University of California","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Carrion-Rodriguez","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California","place":["Los Angeles, CA, United States"]},{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, VA Greater Los Angeles Health Care System","place":["Los Angeles, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California","place":["Los Angeles, CA, United States"]},{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, VA Greater Los Angeles Health Care System","place":["Los Angeles, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela K.","family":"Combe","sequence":"additional","affiliation":[{"name":"Division of Informatics, Clinical Epidemiology and Translational Data Science, Oregon Health & Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M.","family":"Jungbauer","sequence":"additional","affiliation":[{"name":"Division of Informatics, Clinical Epidemiology and Translational Data Science, Oregon Health & Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System","place":["Los Angeles, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Lee","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System","place":["Los Angeles, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Cellular and Molecular Medicine, Herbert Wertheim College of Medicine, Florida International University","place":["Miami, FL, United States"]},{"name":"Geriatric Research, Education and Clinical Center, VA Miami Healthcare System","place":["Miami, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armand M.","family":"Ryden","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California","place":["Los Angeles, CA, United States"]},{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, VA Greater Los Angeles Health Care System","place":["Los Angeles, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Informatics, Clinical Epidemiology and Translational Data Science, Oregon Health & Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen F.","family":"Sarmiento","sequence":"additional","affiliation":[{"name":"San Francisco VA Healthcare System","place":["San Francisco, CA, United States"]},{"name":"Division of Pulmonary, Critical Care, Sleep Medicine, & Allergy, University of California","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eilis","family":"Boudreau","sequence":"additional","affiliation":[{"name":"VA Portland Health Care System","place":["Portland, OR, United States"]},{"name":"Department of Neurology, Oregon Health & Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle R.","family":"Zeidler","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California","place":["Los Angeles, CA, United States"]},{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, VA Greater Los Angeles Health Care System","place":["Los Angeles, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1164\/ajrccm.163.1.2001008","article-title":"Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep heart health study","volume":"163","author":"Shahar","year":"2001","journal-title":"Am J Respir Crit Care Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/S0140-6736(05)71141-7","article-title":"Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study","volume":"365","author":"Marin","year":"2005","journal-title":"Lancet Lond Engl"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2034","DOI":"10.1056\/NEJMoa043104","article-title":"Obstructive sleep apnea as a risk factor for stroke and death","volume":"353","author":"Yaggi","year":"2005","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1080\/15402002.2018.1545649","article-title":"Association of anxiety and depression in obstructive sleep apnea patients: a systematic review and meta-analysis","volume":"18","author":"Garbarino","year":"2020","journal-title":"Behav Sleep Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1378\/chest.11-2214","article-title":"Neurocognitive impairment in obstructive sleep apnea","volume":"141","author":"Lal","year":"2012","journal-title":"Chest"},{"key":"B6","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.smrv.2017.03.005","article-title":"Cognitive deficits in obstructive sleep apnea: insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation","volume":"38","author":"Olaithe","year":"2018","journal-title":"Sleep Med Rev"},{"key":"B7","article-title":"Obstructive sleep apnea: overview of management in adults","volume-title":"UpToDate","author":"Malhotra","year":"2024"},{"key":"B8","doi-asserted-by":"publisher","first-page":"263","DOI":"10.5664\/jcsm.27497","article-title":"Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults","volume":"5","author":"Epstein","year":"2009","journal-title":"J Clin Sleep Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1056\/NEJM199304293281704","article-title":"The occurrence of sleep-disordered breathing among middle-aged adults","volume":"328","author":"Young","year":"1993","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"101358","DOI":"10.1016\/j.smrv.2020.101358","article-title":"Prevalence and management of sleep disorders in the veterans health administration","volume":"54","author":"Folmer","year":"2020","journal-title":"Sleep Med Rev"},{"key":"B11","year":""},{"key":"B12","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.5664\/jcsm.7934","article-title":"National expansion of sleep telemedicine for veterans: the TeleSleep program","volume":"15","author":"Sarmiento","year":"2019","journal-title":"J Clin Sleep Med"},{"key":"B13","year":""},{"key":"B14","doi-asserted-by":"publisher","first-page":"501","DOI":"10.5665\/sleep.5514","article-title":"Remote ambulatory management of veterans with obstructive sleep apnea","volume":"39","author":"Fields","year":"2016","journal-title":"Sleep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e016242","DOI":"10.1136\/bmjopen-2017-016242","article-title":"Telehealth and patient satisfaction: a systematic review and narrative analysis","volume":"7","author":"Kruse","year":"2017","journal-title":"BMJ Open"},{"key":"B16","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1258\/jtt.2007.070709","article-title":"Home-based telehealth: a review and meta-analysis","volume":"14","author":"Dellifraine","year":"2008","journal-title":"J Telemed Telecare"},{"key":"B17","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s11606-015-3489-x","article-title":"Patients\u2019 satisfaction with and preference for telehealth visits","volume":"31","author":"Polinski","year":"2016","journal-title":"J Gen Intern Med"},{"key":"B18","first-page":"e302","article-title":"Review of Veterans Health Administration telemedicine interventions","volume":"16","author":"Hill","year":"2010","journal-title":"Am J Manag Care"},{"key":"B19","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s12913-021-06080-5","article-title":"Leveraging telehealth to improve access to care: a qualitative evaluation of Veterans\u2019 experience with the VA TeleSleep program","volume":"21","author":"Nicosia","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1089\/tmj.2015.0047","article-title":"Impact of sleep telemedicine protocol in management of sleep apnea: a 5-year VA experience","volume":"22","author":"Baig","year":"2016","journal-title":"Telemed J E Health"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.5665\/sleep.4898","article-title":"Web-Based access to positive airway pressure usage with or without an initial financial incentive improves treatment use in patients with obstructive sleep apnea","volume":"38","author":"Kuna","year":"2015","journal-title":"Sleep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1089\/tmj.2015.0055","article-title":"VA Telemedicine: an analysis of cost and time savings","volume":"22","author":"Russo","year":"2016","journal-title":"Telemed J E Health"},{"key":"B23","year":""},{"key":"B24","year":""},{"key":"B25","doi-asserted-by":"publisher","first-page":"CAT-24","DOI":"10.1056\/CAT.24.0132","article-title":"Elevating quality, outcomes, and patient experience through value-based care: CMS innovation center\u2019s quality pathway","volume":"5","author":"Bernheim","year":"2024","journal-title":"NEJM Catal"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e220326","DOI":"10.1001\/jamahealthforum.2022.0326","article-title":"Selecting and implementing patient-reported outcome and experience measures to assess health system performance","volume":"3","author":"Bull","year":"2022","journal-title":"JAMA Health Forum"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1645","DOI":"10.5664\/jcsm.9266","article-title":"Patient experiences with telehealth in sleep medicine: a qualitative evaluation","volume":"17","author":"Donovan","year":"2021","journal-title":"J Clin Sleep Med JCSM"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.5664\/jcsm.11692","article-title":"Effectiveness of mailed versus in-person PAP initiation in the veterans Affairs\u2019 TeleSleep program","volume":"21","author":"Gomez","year":"2025","journal-title":"J Clin Sleep Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.chest.2016.11.049","article-title":"Factors contributing to unintentional leak during CPAP treatment: a systematic review","volume":"151","author":"Lebret","year":"2017","journal-title":"Chest"},{"key":"B30","doi-asserted-by":"publisher","first-page":"zsz152","DOI":"10.1093\/sleep\/zsz152","article-title":"Predictors of long-term adherence to continuous positive airway pressure in patients with obstructive sleep apnea and cardiovascular disease","volume":"42","author":"Van Ryswyk","year":"2019","journal-title":"Sleep"},{"key":"B31","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.pop.2022.04.002","article-title":"The state of telehealth before and after the COVID-19 pandemic","volume":"49","author":"Shaver","year":"2022","journal-title":"Prim Care"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e52552","DOI":"10.2196\/52552","article-title":"Effects of virtual care on patient and provider experience of the clinical encounter: qualitative hermeneutic study","volume":"26","author":"McCaffrey","year":"2024","journal-title":"J Med Internet Res"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e0293089","DOI":"10.1371\/journal.pone.0293089","article-title":"Understanding satisfaction and dissatisfaction of patients with telemedicine during the COVID-19 pandemic: an exploratory qualitative study in primary care","volume":"18","author":"Pogorzelska","year":"2023","journal-title":"PLoS One"},{"key":"B34","doi-asserted-by":"publisher","first-page":"20552076251404513","DOI":"10.1177\/20552076251404513","article-title":"Patients\u2019 experiences of video consultations: a qualitative systematic review","volume":"12","author":"\u00c4rlebrant","year":"2026","journal-title":"Digit Health"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1760059\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:40:56Z","timestamp":1780378856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1760059\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":34,"alternative-id":["10.3389\/frhs.2026.1760059"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1760059","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"article-number":"1760059"}}