ABSTRACT
Background: In the United Kingdom, the national COVID lockdown was legally enforced on the March 26, 2020. As a result, people with CF were classed as clinically extremely vulnerable and were advised to shield at home. In this hospital outpatient clinics were halted;however, the adultCF service had started using the NuvoAir Home remote monitoring solution with 162 patients already established with home spirometry, video consultations, and data sharing with the clinical team. Our aim was to evaluate our experience of replacing all face-to-face clinical reviews with video consultations supported by self-monitoring, at pace and scale during the COVID-19 pandemic. Methods:FromApril2020, 2 members of the CF MDT started contacting all patients not on the NuvoAir Home platform (n=418)to discuss the virtual service and askiftheywere interested in joining. Onconsent, patients were given access to the platform, taught how to download the app, and told how to set up the spirometers (which were posted to them) and how often to perform spirometry. A dedicated email address and telephone line were set up for technical support. Patients were sent an SMS reminder via the platform to complete their spirometry prior to a video clinic appointment but also encouraged to monitor their spirometry at other times to build a personalized trend. Results: To date (March 31, 2021) 558 patients have been onboarded to the remote monitoring program. Pre-pandemic (month of March 2020), 417 spirometry sessions were recorded and 82 video consultations performed. Midway through (in the month of August 2020) n = 539 spirometry sessions had been recorded, with n = 325 video consultations, and in the month of March 2021, n = 609 spirometry sessions and n = 438 video consultations were recorded. Twenty-eight percent of spirometry sessions were unrelated to a video clinic. Total spirometry sessions for April 1, 2020, through March 31, 2021, were n = 6,969. Using ATS criteria n = 5,264 (76%) sessions were graded acceptable (A-D), and n = 1,705 (24%) sessions graded E+F. Reasons patients performed extra spirometry included: checking the effectiveness of treatment change, pre-clinic consultation, feeling unwell, and recovery after an exacerbation. Conclusion: We now have 558 adults with CF onboarded to the virtual platform. Although patients are reminded to do spirometry before an appointment, many also choose to self-monitor their health between clinic consultations. Clinician confidence in self-monitoring is supported by the grading of spirometry sessions using ATS criteria;the best is selected by the software. The platform is now also widely used by the CF MDT for one-to-one or small group support and education sessions. There are a small number of patients (n = 5) who do not wish to use this service for various reasons, including reluctance to change the status quo, hearing impairment, and access to technology. Alternatives are in place for those individuals. Moving the service forward we have added weighing scales and activity trackers, and organized postal, self-administered finger prick blood tests (e.g., liver function tests) and sputum samples. Patients have reported high satisfaction with the service as they are gaining more time for work, education, and family life, as well as saving money. However, they have also reported missing face-to-face contact. We are therefore working closely with patients to devise a hybrid virtual/face-to-face service for the future.