Hospital Hub: Spotlight

Digital Health in CF Outpatient Care - virtually ideal!

C Power, G Leen, G Connell, E Kilbride, O Ahmareen, P Greally & B Elnazir Respiratory Division, CHI @ Tallaght University Hospital, Dublin 24.

Ireland has the greatest prevalence of Cystic Fibrosis per capita in the world. 42% of the Irish CF population are under 18 years. According to the national model of care (2019) for CF, 1,377 people with CF (PWCF) were seen in Irish hospitals in 2017 and 16.3% of these attended more than one hospital for their CF care. Regular interaction between patients and their specialist team is an essential part of care in a serious chronic health condition such as CF, however, the burden of this care for the patient is significant; the need for time off education and work, often travelling long distances to attend appointments as well as bearing the costs associated with such visits. Accessing health care has been particularly challenging to those living remotely. The national model of care for CF has acknowledged this burden and states:

“In areas with challenging geographical access, where outreach and virtual clinics could be of benefit, rollout of high-speed broadband to remote areas may facilitate more regular and useful staff / PWCF interactions. This would complement, not replace, the need for regular face to face meetings with the CF team. The development of home testing solutions might further add to this.”

There is no better time to implement such solutions. We now live in a digital era. Almost 80% of Irish premises have access to high speed broadband and over 90% of Irish people have a smartphone. The widespread availability of personal technology offers patients and clinicians the opportunity to use real-time virtual communication platforms to enhance access to health care services. In recent months, the process of implementing telemedicine has been fast tracked at an enormous pace. The COVID-19 pandemic has led to a sudden explosion in the uptake of digital health tools across the world and has accelerated the adoption of telemedicine.

When faced with the risk of contracting or spreading a highly contagious novel virus, it is apparent that in-person outpatient clinic appointments are impractical, and for many patients, concerning and potentially dangerous. Health services have reacted quickly, embracing digital health, to protect patients and to ease the pressure on services by reducing face to face consultations to only when necessary. In Ireland, virtual clinics are now commonplace, with patient consultations carried out via telephone or digital platforms with built in video and audio.

In recent months, Tallaght University Hospital has introduced numerous new digital solutions to assist patient care. The Paediatric Cystic Fibrosis team are using a combination of telephone appointments, audiovisual platforms ‘Attend Anywhere’ and spirometry devices such as ‘Nuvoair’, M power and a limited number of face-to face appointments for patients requiring urgent review.

We started with NUVOAIR, which is basically a portable spirometry lab which takes all the critical measurements needed for the CF team to understand your lung health. It is Battery-powered and talks by Bluetooth to any kind of phone or tablet that’s had a special app downloaded. In real-time, the CF team, can see how you are doing and adjust their medication or organise urgent face to face review if necessary. Supervised Physiotherapy sessions via video platforms have proved very helpful to many young PWCF.

The National model of care for CF recommends 4 out-patient visits per year when medically stable and more often when a patient is unstable. Platforms such as ‘Nuvoair’, Mpower and ‘Attend anywhere’ allow us to carry out, in stable patients, some of these consultations virtually. Reducing the time, cost and travel burden associated with these appointments is advantageous for patients, while the specialist team can maintain continuity of care with regular appointments and keep close eye on our more unwell patients frequently with no increased risk of exposure to coronavirus.

Our experience with using these platforms has been extremely positive thus far. Patients feedback have indicated that they would rather have their FEV1 measured from the comfort of their home as some live a long way from the hospital. This is obviously coupled with the understandable worry about cross infection risk. Others have indicated that the portable spirometry gives them the confidence that they are doing well from a lung health point of view.

The technology will undoubtedly become smarter and with the advent of machine learning and artificial intelligence, the hope is that we will be able to identify predictive signals for early detection of acute pulmonary exacerbations. We shall also be able to assess treatment response in PWCF and we hope that this technology will be offered to all our eligible patients in the near future.