ABSTRACT
Background: Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in people with cystic fibrosis (CF), affecting approximately 20% of adolescents and 40% to 50% of adults [1]. CF care guidelines recommend screening for CFRD using the 75-gram 2-hour oral glucose tolerance test (OGTT) yearly beginning at 10 years old. Our CF center had a below-average percentage of eligible patients adequately screened for CFRD (65% total screened [only 36% with recommended OGTT] vs ~63% nationally) because of use of a non-preferred screening method and a wide clinic catchment area.We initiated a quality improvement project to increase the percentage of eligible people with CF appropriately screened according to recommended CF care guidelines. Method(s): We began in 2019 by reviewing current data and processes to understand our baseline, goals, and anticipated barriers. We then established the goals of our project with proposed interventions and obtained institutional reviewboard approval. The three goals of our project were to fully eliminate use of the non-preferred screening method by the end of 2020, streamline local OGTT location options for families that live far from our CF center, and increase the percentage of eligible patients screened via OGTT by 20% by the end of 2020.We accomplished these goals by educating families regarding the recommended CFRD screening by OGTT in our CF newsletter;surveying families on how, when, and where they would like to complete their OGTT;and creating an OGTT informational brochure including three selected locations across our clinic geographical coverage area where OGTT can be reliably obtained. An additional goal was added in January 2022 because our percentage of appropriately screened patients dropped in 2021.We aimed to increase our percentage of eligible patients screened by 10% for the year. We are doing this by changing the location of an outlying OGTT facility after receiving negative feedback from our patients. Result(s):We fully eliminated use of the non-preferred screening method by 2020;all patients screened in 2020 were done by OGTT. We increased our total screening percentage from 65% in 2019 to 86% percent in 2020, despite difficulties created by the COVID pandemic. Our screening percentage dropped to 78% in 2021, but we have worked to offer OGTT at one of our associated pediatric clinic locations to better serve families. Conclusion(s): Using traditional quality improvement methods and processes, we eliminated use of a non-preferred CFRD screening method in our pediatric CF clinic. We have increased our screening rates to above the national average and continue to work on improving the CFRD screening process for our patients and families.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
ABSTRACT
Objectives: The SARS-CoV-2 pandemic necessitated restructuring of outpatient services with increased reliance on telemedicine. Greater use of virtual clinics (VCs) is expected to continue;However, patient and clinician satisfaction with these are poorly understood, as are their environmental and fiscal impact. Methods: The first, middle and last patients from various Urological subspeciality VC lists over a 30-day period at the peak of the pandemic were contacted. Healthcare professionals independent of initial care evaluated patient satisfaction using a custom questionnaire. Environmental and fiscal cost analyses were calculated using patient addresses, NHS tariff data and Gross Value Added (GVA) per head. Simultaneously, an online survey exploring changes to outpatient practices and clinician satisfaction with VC was distributed to UK Urologists. Results: 1146 patients underwent VC (30th March - 30th April 2020). 99 patients were contacted. 55 (56%) completed all survey questions (male: 78%, age >65: 60%, follow up: 78%). 49 (89%) were satisfied/very satisfied, with reduced time and travel having the strongest influence on responses. Approximately 5.31 tonnes of C02 emissions were avoided. Estimated cost-savings were £42,714.55 to the NHS and £62,078.82 to the economy. 86 Urologists completed the clinician survey. 83 (97%) switched some/all outpatient activity to virtual, with 69 (80%) using telephone. 24 (28%) felt satisfied/very satisfied for new referrals. 81% (70) felt satisfied/very satisfied for follow up consultations. 61 (71%) would use VC regularly. There were notable variations by subspeciality. Conclusions: VC use should be strongly considered beyond the pandemic, but may not suitable for every patient or subspeciality.