Educational Initiative to Increase Knowledge for Transition to Adult Care in Adolescents With Cystic Fibrosis.

OBJECTIVE: Preparation for transition from pediatric to adult cystic fibrosis (CF) care is essential for successful self-management in adulthood. The primary objective of this study was to determine if education improved performance on follow-up assessments to increase knowledge for transition into adult care. The secondary objective of this study was to identify areas of greatest educational opportunity for adolescent CF patients. METHODS: A knowledge assessment containing 13 multiple-choice questions was given to patients between 14 and 19 years of age. Three educational handouts covering topics including nutrition, pancreatic enzyme replacement therapy, or vitamins were provided when a question corresponding to the topic was answered incorrectly. The same assessment was completed at the next clinic appointment as a follow-up. The scores of initial and follow-up assessments were compared based on number of correct answers. Additionally, the number of educational handouts provided was analyzed to determine area of greatest educational need. RESULTS: The average score ± SD on the initial assessment was 8.3 ± 1.6 of 13 questions answered correctly. For patients who completed both assessments, scores improved significantly between initial and follow-up assessments (8.4 ± 1.8 before education vs 10.3 ± 1.1 after; p = 0.0008). Nutrition, pancreatic enzyme, and vitamin handouts were given to 14 (70%), 17 (85%), and 20 (100%) patients, respectively. CONCLUSIONS: This pharmacist-driven educational initiative increased knowledge assessment scores after education was provided. Future studies of similar knowledge assessments starting at younger ages and other disease topics may determine if targeted education is the optimal way to build knowledge for transition to adult CF care.

A survey assessing the impact of COVID-19 and elexacaftor/tezacaftor/ifavacaftor on both physical and mental health in adults with cystic fibrosis.

In this letter to the editor, we report 82 persons with CF (PwCF) self-reported changes in mental and physical health and potential attribution with either the COVID-19 pandemic and the initiation elexacaftor/tezacaftor/ivacaftor (ETI). Emerging evidence has shown an association with ETI and mental health adverse events. The close proximity of ETI FDA approval and prescribing in PwCF and the COVID-19 pandemic present a challenge in determining the cause of mental health decline. We report 33 (40%) of respondents felt that COVID-19 contributed to a worsening of either their anxiety, depression, or both and 7 (9%) of respondents felt that ETI contributed to a worsening in their anxiety, depression, or both. Eighteen (23%) of respondents felt that ETI had contributed to improvement their mental health. This letter highlights multiple factors that could be impacting mental health beyond ETI. As the COVID-19 pandemic is moving toward an endemic phase, future studies may have more success in deciphering ETI effects on mental health.

Impact of a pharmacy technician and pharmacist on time to inhaled tobramycin therapy in a pediatric cystic fibrosis clinic.

BACKGROUND: Cystic fibrosis (CF) patients who grow Pseudomonas aeruginosa on respiratory culture are commonly prescribed inhaled tobramycin (TIS) to eradicate the organism. The objective of this study was to determine the impact of a pharmacy technician/pharmacist team, in conjunction with an integrated health-system specialty pharmacy (IHSSP), on the time from positive culture to prescribing and access to TIS in a pediatric CF clinic. METHODS: A retrospective study of CF patients positive for P. aeruginosa who were prescribed TIS for eradication. RESULTS: The study included 20 patients in the pregroup and 42 patients in the postgroup. Total median (interquartile range) days from positive culture to TIS being shipped to the patient from the pharmacy was significantly different: 15 (10.25-21) days in the pregroup and 9 (7-14) days in the post groups (p = .005). The time from positive culture to TIS prescribing was significantly different: 6 (5-12.75) days in the pregroup and 5 (3.75-6) days in the postgroup (p = .01). In the postgroup median time from prescription to the patient receiving the TIS was significantly different between the two groups 2 (2-5) days IHSSP group versus 6 (3-9) external specialty pharmacy group (p = .003). Time from prescription to prior authorization approval was the same in both groups. CONCLUSIONS: The addition of the pharmacy team reduced time from culture to TIS being received by the patient. Patients able to fill at the IHSSP received their medication sooner than an external specialty pharmacy. The study shows the benefit of an integrated pharmacy model in conjunction with an IHSSP.