Real-World Outcomes in Cystic Fibrosis Telemedicine Clinical Care in a Time of a Global Pandemic,Chest

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Real-World Outcomes in Cystic Fibrosis Telemedicine Clinical Care in a Time of a Global Pandemic
Chest ( IF 9.5 ) Pub Date : 2021-12-10 , DOI: 10.1016/j.chest.2021.11.035
Lindsay A L Somerville ₁ , Rhonda P List ₂ , Martina H Compton ₂ , Heather M Bruschwein ₃ , Deirdre Jennings ₄ , Marieke K Jones ₅ , Rachel K Murray ₆ , Elissa R Starheim ₁ , Katherine M Webb ₇ , Lucy S Gettle ₆ , Dana P Albon ₁

Affiliation

Background

During the COVID-19 pandemic, the University of Virginia adult cystic fibrosis (CF) center transitioned from in-person clinical encounters to a model that included interdisciplinary telemedicine. The pandemic presented an unprecedented opportunity to assess the impact of the interdisciplinary telemedicine model on clinical CF outcomes.

Research Question

What are the clinical outcomes of a care model that includes interdisciplinary telemedicine (IDC-TM) compared with in-person clinical care for patients with CF during the COVID-19 pandemic?

Study Design and Methods

Adults with CF were included. The prepandemic year was defined as March 17, 2019, through March 16, 2020, and the pandemic year (PY) was defined as March 17, 2020, through March 16, 2021. Patients were enrolled starting in the PY. Prepandemic data were gathered retrospectively. Telemedicine visits were defined as clinical encounters via secured video communication. Hybrid visits were in-person evaluations by physician, with in-clinic video communication by other team members. In-person visits were encounters with in-person providers only. All encounters included previsit screening. Outcomes were lung function, BMI, exacerbations, and antibiotic use. FEV₁ percent predicted, exacerbations, and antibiotic use were adjusted for the effect of elexacaftor/tezacaftor/ivacaftor treatment.

Results

One hundred twenty-four patients participated. One hundred ten patients were analyzed (mean age, 35 years; range, 18-69 years). Ninety-five percent had access to telemedicine (n = 105). Telemedicine visits accounted for 64% of encounters (n = 260), hybrid visits with telemedicine support accounted for 28% of encounters (n = 114), and in-person visits accounted for 7% of encounters (n = 30). No difference in lung function or exacerbation rate during the PY was found. BMI increased from 25 to 26 kg/m² (t₁₀₀ = –4.72; P < .001). Antibiotic use decreased from 316 to 124 episodes (z = 8.81; P < .0001).

Interpretation

This CF care model, which includes IDC-TM, successfully monitored lung function and BMI, identified exacerbations, and followed guidelines-based care during the pandemic. A significant decrease in antibiotic use suggests that social mitigation strategies were protective.

Trial Registry

ClinicalTrials.gov; No.: NCT04402801; URL: www.clinicaltrials.gov.

中文翻译：

全球大流行时期囊性纤维化远程医疗临床护理的真实世界结果

背景

在 COVID-19 大流行期间，弗吉尼亚大学成人囊性纤维化 (CF) 中心从面对面的临床接触转变为包括跨学科远程医疗在内的模型。大流行为评估跨学科远程医疗模型对临床 CF 结果的影响提供了前所未有的机会。

研究问题

与 COVID-19 大流行期间 CF 患者的面对面临床护理相比，包含跨学科远程医疗 (IDC-TM) 的护理模式的临床结果是什么？

研究设计和方法

包括患有 CF 的成年人。大流行前年定义为 2019 年 3 月 17 日至 2020 年 3 月 16 日，大流行年 (PY) 定义为 2020 年 3 月 17 日至 2021 年 3 月 16 日。患者从 PY 开始入组。回顾性收集大流行前数据。远程医疗访问被定义为通过安全视频通信进行的临床接触。混合访问是由医生亲自评估，其他团队成员在诊所进行视频交流。面对面访问仅与面对面的提供者会面。所有的遭遇都包括访问前筛选。结果是肺功能、BMI、恶化和抗生素使用。根据 elexacaftor/tezacaftor/ivacaftor 治疗的效果调整了预测的FEV _{1 %、恶化和抗生素使用。}

结果

一百二十四名患者参加。分析了 110 名患者（平均年龄 35 岁；范围 18-69 岁）。95% 的人可以使用远程医疗（n = 105）。远程医疗就诊占就诊的 64% (n = 260)，具有远程医疗支持的混合就诊占就诊的 28% (n = 114)，面对面就诊占就诊的 7% (n = 30)。没有发现 PY 期间肺功能或恶化率的差异。BMI 从 25 增加到 26 kg/m ² ( t ₁₀₀ = –4.72; P < .001)。抗生素使用从 316 次减少到 124 次（z = 8.81；P < .0001）。