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Many in the low socio-economic status group are not well educated. They maybe having trouble with meeting their everyday needs such as food, clothing, shelter, and ecking by with little hope of ever having more. Many do not have the resources available to even know about, let alone try to understand, what sleep apnea is. Their reading skills may not be to the level that reading literature or even, a newspaper, is very difficult. Many do not have access to the internet, either because of affordability or lack of communication skills (it takes a certain amount of communication skills to do searches on the internet and then be able to distinguish fact from fantasy -- ie snake oil remedies).
Think about it, your choices are buying a machine (with very little understanding of why) or paying for very basic needs for a significant period of time. Paying for basic needs is going to win hands down.
I am not trying saying that those in the lower economic bracket should be forgotten about. On the contrary -- affordable means of diagnosing and treatment options should be available, along with the education to understand the importance of compliance.
My mom has some experience with the way medicaid handles OSA and cpap. She'd already had a machine and mask from years before, but needed a new one. Once she finally was eligible for medicaid, she went to get help with her sleep apnea. She was given a new mask (no choice in the mask) and sent out the door. No instruction on fitting the mask or offers to swap it out or anything. The mask she got was the Comfortselect Nasal Mask. Not a stellar one, and one that definitlely requires some instruction and help with fitting in my opinion.
She came for a visit not too long after getting it, and I was able to help her with it, but still! Not a lot of folks would be able to have someone in the family who could help them. I think my experience with the company who handled my cpap supplies defintely helped me to be more committed to my therapy. They were so helpful and supportive, always would let me swap out masks and send me away with lots of extra supplies like a new hose and filters, stuff that I wouldn't have thought to ask for, and that my mom certainly doesn't get! In fact I have saved my new hoses to give to her sometimes.
I think the care and support we tend to get as insured people is probably a huge contributor to the difference in compliance.
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