Telemedicine clinics for people with cystic fibrosis (CF): experiences 18 months on

Introduction: At the start of the 2020 COVID-19 pandemic, our adult CF unit established a telemedicine service to deliver clinical care for people with CF (pwCF). We previously assessed the impact of this change during the UK lockdown, with audio-visual quality and home spirometer connectivity issues identified as barriers to service delivery.1 Despite the cessation of lockdown and shielding advice for pwCF, this service continues at our centre. Physiologist-led home spirometer coaching, provision of postal sputum surveillance and face-to-face (FTF) consultations offered to selected individuals have attempted to address these issues. Methods: We designed a cross-sectional survey of 18 rating-scale questions to evaluate perceptions of our telemedicine service, which was sent to all pwCF registered to our centre, via the AccuRx service. Results: A total of 64/365 (18%) responded (see table). Respondents rated their overall telemedicine experience as positive and 88% preferred telemedicine over FTF consultations. 92% rated the service as efficient as compared to 86% people previously. 99% reported good audio-visual quality, up from 68% previously. Conclusion: Telemedicine services continue to be an efficient means of outpatient service delivery for pwCF. (Table Presented)

Evaluating the impact of a telemedicine service during the COVID-19 pandemic in people with cystic fibrosis

Introduction: To provide continuity of care during the COVID-19 pandemic, our large adult CF unit implemented a telemedicine service in order that people with cystic fibrosis (pwCF) - categorised as ‘extremely clinically vulnerable’ in the UK – could access clinicians during periods of shielding. Here we report their opinions of and engagement with the service during the early pandemic. Methods: A total of 44 consecutive pwCF attending virtual clinics completed a 23-part survey composed of free text and rating scale questions to evaluate the impact of the telemedicine service and the pandemic on their CF care. We also compared telemedicine and face-to-face (FTF) appointment attendance rates during the pandemic. Results: Feedback was generally positive (see Table). The main areas of constructive criticism revolved around audio and visual quality, as well as connectivity issues associated with use of mobile devices to access the telemedicine portal. Positive comments of the telemedicine clinic included no travel requirements, and no risk of cross-infection. Between July and October 2020, attendance was higher at FTF appointments than telemedicine (166/186 vs 417/513, Chi-squared p = 0.01). [Table Presented]] Conclusions: The telemedicine service is generally popular with pwCF, and engagement with the service has been good. Clinicians need to be aware that technology issues may hamper appointment attendance and interaction for some users.

Facilitating cystic fibrosis research during the COVID-19 pandemic

Objectives: Although clinical research is an important part of the management of people with cystic fibrosis (pwCF), the COVID-19 pandemic has had a profound impact on research activity, especially that which involves such clinically extremely vulnerable groups. Methods: We describe our experience with continuing CF research activity during the pandemic crisis at our large adult unit (~350 pwCF). We use a bespoke CF single-person research suite that includes a lounge area incorporating hotel facilities, separate from the main clinical buildings. Results: At the start of the COVID-19 pandemic, 104 pwCF in 6 active trials (4 requiring physiologic tests) wished to carry on with their routine trial visits. One study (54 participants) was put on hold at the request of the sponsor. All pwCF were risk assessed before attending to comply with guidelines. From March to December 2020, we carried out 3 sweat tests,15 blood tests and 50 spirometry tests in the suite, and 50 research imaging and 10 full pulmonary function tests within another setting. All procedures were carried out using appropriate personal protective equipment (PPE), with staff fit-tested to perform spirometry safely. Feedback from pwCF indicated that they felt safe and secure in addition to being supported. Conclusion: With the implementation of measures such as face coverings, health screens, and social distancing, most research activity within CF presents a relatively low risk for individuals despite the challenges faced. Having a bespoke facility allowed us to ensure the safety of research participants, minimise the risk of COVID-19 community spread, including spread to the researchers themselves and the avoidance of interactions with non-research staff. We continue to adapt our strategies to make the best out of available resources and opportunities.

Provision of home spirometry in a physiologist-led service: experiences from a large adult cystic fibrosis centre

Objectives: Spirometry is an important marker of lung health in people with cystic fibrosis (pwCF). During the SARS-CoV-2 pandemic, the aerosol-generating nature of spirometry coupled with service user shielding disrupted its routine monitoring. To maintain continuity, we implemented a home spirometry service to complement our telemedicine clinic. Methods: We provided NuvoAir Air Next© home spirometers in clinic or by courier to those of our adult CF cohort with good service engagement and spirometry technique. Training and instruction was given by ARTP-registered physiologists, who are also available at telemedicine clinics to grade spirometry and offer support to service users. Results are uploaded by pwCF via a connected phone. We report our experiences, and the quality of independently-performed home spirometry as graded against ATS/ERS guidelines. Results: Over 4 months, we provided 302 of the 354 pwCF attending our centre with spirometers ([mean ± SD] age 32 ± 11 years (range 17–76), BMI 23.4 ± 4 kgm–2, % predicted FEV1 76.5 ± 23.6. Of the 300, 2 did not tolerate home spirometry, one due to an incompatible phone, and one due to poor compliance. 20 (6.8%) pwCF have yet to use their spirometer. 278 (93%) have performed a total of 5,344 manoeuvres across 1,636 sessions (mean sessions 5.8, mean interval 14.9 days, see Table). We report no adverse events. Quality of spirometry below grade D was often repeated after physiologist feedback. Grade E spirometry was often recorded when only a single acceptable spirometry was performed (20%) or when end-of-test criteria had not been met (46.4%). [Table Presented] Conclusion: Home spirometry can be implemented in a large cohort in a short time frame. Engagement and quality of independently performed spirometry in this group of expert performers was high, but falls below that of hospital quality spirometry. The availability of physiologists to support this service in real-time is an important factor in this and in the reinforcement of reproducible spirometry.