ABSTRACT
Background: Highly effective modulator therapy (HEMT) is now available for ∼90% of adults with CF with Kaftrio® licenced for use in the UK from August 2020. Despite continuation of routine CF treatments in randomised controlled trials, real-world evidence suggests a reduction in prescribed inhaled medication for people with CF on HEMT.1 Alongside the introduction of Kaftrio®, additional factors have impacted upon our inhaled medication prescribing practice including the COVID-19 pandemic and the introduction of CFHealthHub, which allows us to monitor nebulised treatment adherence. Objective: To examine how and to what extent our inhaled medication prescribing practice has changed over the past 5 years. Method: A retrospective audit of our prescribed inhaled medication databases from 2016, 2019 and 2021. Results: See table 1. Table 1. Number of CF patients prescribed inhaled mucolytics and long term inhaled therapy for Pa. (Table Presented) Conclusion: Despite an increasing rate of Pa infection,we have observed an overall reduction in prescribing of inhaled antibiotics and mucolytics. HEMTs, particularly Kaftrio®, have improved the health of our patients and, despite our caution, many have requested a reduction of inhaled therapy in line with their improved well-being. Assessment of adherence via CFHealthHub has often led to rationalisation of inhaled treatments in order to support improved adherence. During the COVID-19 pandemic, drug response assessments, the gateway to accessing a change in inhaled medication, have frequently been delayed as we have had to redesign our service in response to changing circumstances.
ABSTRACT
Background: In the first wave of the COVID-19 pandemic, people with cystic fibrosis (pwCF) in the UK were asked to ‘shield’ at home whilst many specialist CF staff were redeployed. CF services had to rapidly adapt to the changing circumstances and traditional roles were blurred as services were redesigned to try to maintain quality CF care alongside minimising risk of COVID-19. Objective: To examine the impact of COVID-19 on the prescribing practice of CF physiotherapist non-medical prescribers (CFPT-NMPs) in the UK. Method: A bespoke online questionnaire was sent to all members of the ACPCF NMP group in July 2020. Results: 19/27 CFPT-NMPs completed the questionnaire (6 adults, 12 kids and 1 both). A greater proportion of adult CFPT-NMPs (6/6, 100%) than kids (3/12, 25%) or both (0/1, 0%) had been redeployed to non-CF areas. All reported COVID-19 had changed their prescribing practice, with an overall trend towards prescribing outside their CF speciality 5/8 (63%). In adults the trend was towards less frequent prescribing (4/5, 80%) with an increase in the different types of medication prescribed (3/4, 75%);in kids there was an increase in frequency of prescribing (7/10, 70%) but no trend in change of types of medication prescribed. 14/18 (78%) reported a delay or cessation in completing non-urgent drug response assessments (DRAs). The 22% of respondents reporting no delay in DRAs were working in kids. The 11/18 (61%) who had completed DRAs reported large variability within the DRA process, specifically around use of PPE and outcome measures. Conclusion: COVID-19 has significantly impacted the delivery of CF care and CFPT-NMP's prescribing practice. Many DRAs, the gateway to pwCF accessing appropriate inhaled medications, have been delayed. This was more likely in the adult population, highlighting the greater impact COVID-19 has had on adult CF services. COVID-19-specific DRA guidance has subsequently been produced by our ACPCF NMP group, facilitating timely and safe practice nationally.