Queensland Health Sleep Disorders Program: Information for clinicians
Novel coronavirus (COVID-19) and CPAP
The Queensland Health Sleep Disorders Program (QHSDP) is a statewide clinical scheme that manages the treatment of patients with sleep disorders, including those with obstructive and central sleep disordered breathing, insomnia, hypersomnolence, behavioural sleep disorders and parasomnias. The Program is administered by an Executive Committee comprising clinical directors, senior scientific and nursing representatives from our nine QHSDP Prescriber Centres and the Program Administrator. The Program is hosted by Metro North Hospital and Health Service.
Our services include:
- Consultation with dedicated sleep medicine specialists
- Advanced sleep investigation and diagnostic tests
- Monitoring of patient treatment and adherence to therapy
- Long-term loan of in-home therapy devices including Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (Bi-Level) breathing assistance devices—to eligible patients
- Patient education, support and follow-up.
QHSDP Prescriber Centres are located at:
- Cairns Hospital, Cairns North
- Gold Coast University Hospital, Southport
- Queensland Children’s Hospital, South Brisbane
- Sunshine Coast University Hospital, Birtinya
- Mater Public Health Services, Brisbane
- Princess Alexandra Hospital, Woolloongabba
- Royal Brisbane & Women's Hospital, Herston
- The Prince Charles Hospital, Chermside
- Townsville Hospital, Douglas.
Our clinicians work closely with public and private specialists, general practitioners and other healthcare professionals. Besides providing day-to-day care, QHSDP's clinical teams have a strong future focus. New treatments and technology are regularly reviewed, aimed at providing the highest quality care for all our patients.
Refer a patient to Queensland Sleep Disorders Program
To access the Program, patients need a medical doctor's referral to a QHSDP Prescriber Centre. Further eligibility requirements apply to the equipment loan scheme.
If sleep investigations are performed by a non-Queensland Health facility, full diagnostic and/or treatment information must be forwarded to the QHSDP Prescriber Centre with the doctor's referral.
Further investigations may be required to be repeated at the QHSDP Prescriber Centre at the discretion of the Sleep Specialist. All bilevel investigations must be performed in a QHSDP Prescriber Centre.
The QHSDP Prescriber Centre prioritises clinical review of patients using the Respiratory and Sleep Clinical Prioritisation Criteria.
Any patients who are already on CPAP before medical assessment at the QHSDP Prescriber Centre will need to provide objective evidence of CPAP usage of at least a two-month period at the medical assessment before the provision of QHSDP Program equipment occurs. To determine objective CPAP usage, the Program must know the treatment start and finish dates as well as the total hours of usage during that period. This data can be provided as a report by the CPAP rental organisation.
Equipment loan scheme eligibility
National Disability Insurance Scheme (NDIS)
NDIS participants will be able to receive funding through their NDIS plans for the disability-related health related supports they need as a direct result of their disability, and as part of their daily life. This funding includes disability-related health supports for participants who need help with respiratory care as outlined below:
- development and periodic review of clinical care and daily maintenance of tracheostomy (insertion, removal and change) by an NDIS-funded suitably qualified and competent clinician
- implementation of daily maintenance of tracheostomy (insertion, removal and change) by an NDIS-funded suitably qualified and competent worker
- training of an NDIS-funded suitably qualified and competent worker to provide tracheostomy maintenance and care.
- provision of tracheostomy equipment and consumables
- provision of a Constant Positive Airway Pressure machine (CPAP) machine and consumables
- provision of a Bilevel Positive Airway Pressure (BIPAP) machine and consumables
- provision of a ventilator, air humidifier, portable suction machine and/or cough assist machine and consumables
- assistance with the use of all respiratory medical equipment as well as the training of a suitably qualified and competent worker to use the equipment.
If you think your patient qualifies for this funding, encourage them to discuss the matter with their NDIS support worker or planner. More information is available on the NDIS website.
Department of Veteran Affairs (DVA) Gold Card
The Gold Repatriation Health Card (DVA Gold Card) is issued to Australian veterans, their widows and dependants. The gold card entitles the holder to treatment for all medical conditions.
If your patient has presented with a DVA Gold card and is confirmed as needing Positive Airway Pressure treatment, you can use the D9140 form (Application for PAP Equipment) to apply for CPAP or BPAP devices and accessories. As the treating clinician you can request the device and accessories most suitable for the patient regardless of the manufacturer and tender holder for DVA PAP equipment. The tender holder for DVA PAP equipment will source the equipment prescribed. More information is available on the DVA website.
QHSDP equipment loan scheme
QHSDP's equipment loan scheme assists patients who can least afford to purchase their own sleep therapy device. To be considered for this scheme, patients must:
- Hold a current Pensioner Concession Card, Health Care Card or Department of Veterans’ Affairs (DVA) white card. Commonwealth Seniors Health Care Card holders are not eligible.
- Reside permanently in Queensland
- Have been diagnosed with significant sleep apnoea as defined by the Queensland Sleep Disorders Program:
- Apnoea Hypopnoea index (AHI) of ≥ 15/hour on a diagnostic sleep study associated with excessive daytime sleepiness or other symptoms of sleep apnoea including choking or gasping during sleep, recurrent awakenings from sleep, unrefreshing sleep, daytime fatigue and impaired concentration and/or memory; OR
- Obstructive sleep apnoea of any severity associated with excessive daytime sleepiness as defined by an Epworth Sleepiness Scale (ESS) of ≥ 10/24 where other causes for the symptoms have been excluded.
Additionally, patients are required to:
- Rent a positive airway pressure device at their own expense for a minimum 2-month home treatment trial with average usage of at least 4 hours per night over this period.
- Purchase their own device accessories - including mask, headgear, and (if required) humidification.
- Be under the management of a Royal Australasian College of Physicians Accredited Sleep Physician in a QHSDP Prescriber unit.
Note: Patients with mild Sleep Apnoea (AHI <15/hr) without significant daytime sleepiness (ESS <10/24) require prior approval from the Program Chair/Deputy Chair for issue of equipment. They will consider each application based on the demonstration of other clinical benefit from CPAP treatment, including treatment of symptoms not reflected by the ESS, effects on co-morbidities or the requirement to control other downstream effects of OSA.
Any concerns about the applicant’s eligibility [should] be referred to the QHSDP Executive Chair or the QHSDP Executive Committee. The Executive’s decision in such matters is final.
Objective CPAP compliance must be maintained at a minimum of 4hours/night to retain the loan positive airway pressure device. Those patients who have been reviewed by a QHSDP Prescriber Centre and have suboptimal adherence to CPAP (<4hours/night) will be given a 1-month grace period to improve CPAP compliance. Advice will be provided with regards to specific equipment or health issues affecting compliance. If objective CPAP compliance is <4hours/night during this 1-month grace period, then the pump must be returned to QHSDP.
A nasal mask system costs around $180 - $250. Some patients need a full mask system. This can cost $250 - $350. These costs are indicative only and vary between suppliers.
Although CPAP is the most effective therapy for people with moderate to severe obstructive sleep apnoea, it doesn't suit everybody. The trial period helps to identify any problems.
There's evidence that patients who can successfully use CPAP and feel benefit over a 2-month period generally continue using the therapy in the long-term. Once the trial has been successfully completed and the patient has been clinically assessed by a Royal Australasian College of Physicians Accredited Sleep Physician in a QHSDP Prescriber Centre, a Queensland Health device can be issued.
Please note: Queensland Health does not supply rental devices. The patient’s local QHSD Prescriber Centre can provide advice on how to obtain a rental machine.
Due to the high demand for our services, there might be some delay in accessing a QHSD Prescriber Centre. Waiting times vary from hospital to hospital and are based on medical and occupational priority.
Patients who have already commenced CPAP treatment are advised to continue renting CPAP devices in the meantime. Your local centre will be able to advise you of the approximate waiting time.