An exclusive telehealth care model used during the COVID-19 pandemic was associated with a decrease in pulmonary function in Australian children with cystic fibrosis (CF).

“It is likely that telehealth based care should complement, rather than replace in person assessment,” according to the researchers. “Further work is needed to define the optimal use of this technology.”

The study, “The impact of telehealth based care on paediatric cystic fibrosis outcomes,” was published in the Journal of Cystic Fibrosis.

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The healthcare of people with CF benefits from appointments with a multidisciplinary team. During the COVID-19 pandemic, a telehealth model — meaning the use of digital information and communication technologies rather in-person visits — was adopted in many institutions around the world.

As recommended in guidelines in Australia, patients are evaluated a minimum of four times per year in the CF clinic. In response to the pandemic, all clinics in the country transitioned to a telehealth model, unless there was an urgent indication for in-person assessment.

To learn more about the impact of telehealth on the outcomes of children with cystic fibrosis during the COVID-19 lockdown, researchers in Australia conducted a retrospective analysis of 214 pediatric patients attending a CF clinic at the Royal Children’s Hospital in Melbourne.

They compared clinical data from the year before the COVID-19 pandemic, during the pandemic lockdown, and in the first in-person appointment in 2021 after the lockdown was lifted.

Most participants were boys (58%), with a median age of 11 years (ranging from 1 to 19 years).

Multi-disciplinary telehealth

During the telehealth appointments, the patients and their families could see the entire CF team, which addressed the relevant areas of CF care, including pulmonary, nutritional, and mental health, as well as treatment adherence.

Spirometry measures were taken at home using a portable device for those patients at greater risk of deteriorating pulmonary function.

Each session had the supervision of a qualified respiratory scientist. All patients with a home spirometer completed at least one test for lung function during the 9-month lockdown, in contrast to only half among those without.

Of 164 patients with spirometry data before the pandemic, 144 also had post-lockdown data available.

When comparing pre- to post-lockdown periods, there was an overall reduction of 5.4% in forced expiratory volume in one second (FEV1), a measure of lung function. In 31.9% of the patients, the decrease was superior to 10%.

The median decrease in FEV1 also was greater in participants with home spirometers than in those without (6.5% vs. 3.5%).

More evaluation needed

“While this does not demonstrate a causal relationship between telehealth-based care, and poorer CF outcomes, it does highlight the need for further evaluation of monitoring of telehealth especially given patient and clinician preference for its ongoing use,” the researchers wrote.

The patient’s weight and body mass index, a measure of body fat, remained stable during lockdown. However, changes in height in a growing child or adolescent might have been underestimated, and contribute to an overestimation of FEV1, the scientists suggested.

During lockdown, if the team detected an exacerbation through symptoms or a change in FEV1, treatment was initiated at home with oral antibiotics, and patients who did not improve were admitted to the hospital.

Admission was required at least once for 50 participants, a reduction compared to the year before the lockdown (64 patients). The majority of patients admitted during lockdown (74%) had a home spirometer, and 19% of the admissions were caused by a worsening of pulmonary function.

According to the researchers, this decrease might be, at least partially, related to a reduction in viral infections during the lockdown. However, considering the spirometry results after the lockdown, more patients could have benefited from hospital admission if the lung function decline was detected earlier.

During lockdown, patients were evaluated for the microbes found in their airways, by providing families with equipment and instructions to collect cough swabs and sputum samples.

The number of samples for analysis reduced from a median of five per patient per year before the pandemic, to three during lockdown. In 7% of patients, no sample was obtained during lockdown.

Infection by Pseudomonas aeruginosa occurred in 22% of the patients before the pandemic, 16.8% during lockdown, and 7.5% in the first appointment after lockdown.

“Despite an overall reduction in microbiology samples, our results suggest home samples were sufficient in detecting P. aeruginosa,” the researchers concluded.

According to the team, more work is needed to evaluate methods to include telehealth in routine CF care.

“Methods for home and/or in-person spirometry, anthropometric [body] measurements, and microbiological sample collection need to be easily accessible, with correct training and supervision,” they wrote.

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