ABSTRACT
Objective: The use of intravenous antibiotics (IVAB) is a central part of the management of pulmonary infections in cystic fibrosis (CF). Adult patients with CF in England were advised to “shield” by the government (23.03.2020–01.08.2020) during the COVID-19 pandemic. Shielding was described as the requirement to not leave home and minimise all face-to-face contact. At our adult CF centre in London, there was a 50% reduction in requirement for IVAB, compared to the same period in 2019. We aimed to identify potential factors contributing to the reduced requirement of IVAB during shielding. Method: An 8-point patient questionnaire was given to 27 patients who had required ≥3 courses of IVAB in the year 2019. These were designed to identify: percentage of patients shielding, percentage of patients starting a modulator, variation in adherence to regular medications, chest physiotherapy, and requirement to IVAB. Results: 70% response rate (n = 19). [Table Presented] Despite a 50% reduction in IVAB compared to the previous year, the majority of patients reported their requirement for IVAB remained the same (68%). There was no self-reported increase in adherence to regular medications or chest physiotherapy. The majority of patients felt their overall health status remained stable or improved (78%). During this period the majority of patients fully shielded (84%) and started Symkevi®/Kalydeco or Kaftrio®/Kalydeco (as part of a trial or compassionate use program) (84%). Conclusion: Increased adherence to regular medication and physiotherapy did not appear to be a factor in reducing the requirement for IVAB observed during the UK COVID-19 pandemic lockdown. Adherence to government shielding may have reduced exposure to community acquired infections and associated requirement for IVAB. Commencement of a modulator therapy was likely to have a positive impact on overall health and associated of reduction in requirement of IVAB.
ABSTRACT
Institution: Department of Palliative Care, Beaumont Hospital, Dublin 9, Ireland. Background: The COVID-19 global pandemic has resulted in many deaths and simultaneously altered delivery of many health care services. Aims: To audit the impact of the COVID-19 pandemic upon the delivery of specialist palliative care (PC) in a large academic health centre. Methods: Retrospective chart analysis was carried out on all patients on the PC service over a 6-week period (March/April 2020) and compared to the same period in 2019. Patient demographics, outcomes, and number of reviews were collected, and data were analysed using GraphPad Prism. Results: Thirty-three patients with COVID-19 were referred to the PC service during this period. Total number of referrals to the PC service between 2020 and 2019 was similar. (n = 92 vs n = 99). Patients were reviewed on average twice as frequently in the COVID-19 period compared to the equivalent period in 2019. (0.6660 vs 0.3077 reviews per day on service, P < .0001). There was no significant difference in the number of documented PC reviews in COVID-19 versus non-COVID-19 patients in 2020 (0.7084 vs 0.6250 reviews per day on service, P = .3163). However, COVID-19 patients were reviewed in person 3 times less than non-COVID-19 patients (0.1940 vs 0.6000 reviews per day on service, P = .0002). More patients referred during the pandemic period died in hospital compared to 2019 (60.4% vs 33.3%). The median number of days a PC referral was made prior to death was significantly shorter during the pandemic period (4.5 vs 13 days, P < .0001). Conclusion: Palliative care service was maintained throughout the pandemic period;however, patients with COVID-19 had less in person reviews. The increase in total patient reviews during this period may reflect the role of PC in managing serious illness and augmenting communication at a time of patient isolation. However, in planning PC service provision in the ongoing pandemic, the benefit of early referral for all patients requiring specialist PC should be highlighted.