ABSTRACT
Objectives: Persons with cystic fibrosis (CF) have higher rates of depression and anxiety compared to the general population. The Cystic Fibrosis Foundation and the International Committee on Mental Health in Cystic Fibrosis (ICMH) recommend annual screening for depression and anxiety for people with CF. The COVID-19 pandemic and related social distancing has created challenges for administration of mental health screening by CF centres. The aim of this quality improvement project was to implement mental health screening during multidisciplinary telemedicine appointments for adult patients with CF during the COVID-19 pandemic. Methods: Patients were screened via telemedicine using the PHQ-9 and GAD-7 screening instruments between April and October 2020. Results: Use of telemedicine to conduct screening allowed for a majority of the clinic population (n = 93) to receive mental health screening during a time that health system operations were impacted by the COVID-19 pandemic. Screening did not increase clinic visit length and rates of depression and anxiety were found to be similar to 2019 clinic rates. [Table Presented] Conclusion: Mental health screening during a multidisciplinary telemedicine clinic is feasible and allows CF centres to maintain adherence to mental health screening and treatment guidelines.
ABSTRACT
Introduction: The University of Virginia (UVA) adult cystic fibrosis (CF) program implemented a rapid and successful transition to telemedicine care in mid-March, 2020 in response to the COVID-19 pandemic. In May 2020, the program responded to the re-opening of ambulatory operations for non-acute care by redesigning the care model yet again to create a hybrid encounter type. Hybrid encounters combine elements from both in-person and telemedicine visits. The goal remained to minimize person-to-person contacts for patients and care team members (CTMs) while ensuring patient access to quarterly, co-produced, multidisciplinary CF care. Methods: Using quality improvement methods, the UVA adult CF program created a standardized hybrid model of care for in-clinic visits to include a few in-person interactions combined with up to four virtual interactions with members of the multidisciplinary team. From the CF team, two physicians, the nurse coordinator and social worker attend clinic in person while the registered dietitian, respiratory therapist, psychologist, and quality improvement coordinator attend clinic remotely via a Cisco Webex telehealth platform. All CTM interactions occur within the patient's clinic exam room and hybrid visit types are limited to three per half-day clinic. Results: A total of 16 hybrid visits occurred between May 14, 2020 and June 11, 2020. All hybrid visits were multidisciplinary and fulfilled patient requests to see CTMs. All patients seen by hybrid encounter participated in co-produced agenda setting, underwent spirometry and obtained bloodwork;75% provided sputum for surveillance culture. Each hybrid visit type was attended by an average of four CTMs and amounted to 63 separate interactions. Of these interactions, 28 were completed virtually, reducing in-person contacts and personal protection equipment (PPE) utilization by 44% compared to a fully in-person model of care. Conclusion: Combining in-person and telehealth components in a multidisciplinary CF care model reduces patient and staff in-person interactions and PPE utilization compared to regular clinic visit type. It is feasible to adopt a hybrid model of telehealth for reliable access to biological data and multidisciplinary team members while continuing to minimize personto- person contacts for both patients and staff.