261: Telehealth versus face-to-face annual respiratory education for pediatric outpatient cystic fibrosis clinic visits

Introduction The demand for Hospital in the Home has increased, especially as an avenue for treatment of respiratory exacerbations. However, a limiting factor of Hospital in the Home efficiency is excess travel. Telehealth can potentially increase in-home access to specialist care such as physiotherapy. This study examined clinical outcomes achieved with a hybrid telehealth model and assessed safety and efficiency. Method This study was an observational benchmarking study of Hospital in the Home physiotherapy episodes of care during respiratory exacerbations between January 2017–June 2019. The participants were young people aged 8–18 years, with cystic fibrosis receiving intravenous antibiotics and bi-daily physiotherapy. The intervention was physiotherapy via either a hybrid model (1× telehealth, 1× face-to-face session) or standard care (2× face-to-face sessions). The outcomes were frequency of return to at least 95% of baseline percentage predicted forced expiratory volume in the first second (ppFEV1), ppFEV1 change, adverse events, travel time and distance saved. Results There were 82 episodes of Hospital in the Home; 41 hybrid and 41 standard care. Return to at least 95% of baseline was achieved in 49% of the hybrid group and 32% of standard care. Median ppFEV1 change was +6% for the hybrid group and +2% standard care. There were no adverse events. Estimated travel time and distance saved was 16,520 min and 12,301.2 km. Conclusion Preliminary information supports a hybrid telehealth physiotherapy model as an alternative to standard care for young people with cystic fibrosis during an exacerbation. Safety of telehealth in conjunction with home visits favoured its use to improve efficiency and capacity without added risk.

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Redesigning care to meet national recommendation of four or more yearly clinic visits in patients with cystic fibrosis

BMJ Quality & Safety ◽

10.1136/bmjqs-2013-002345 ◽

2014 ◽

Vol 23 (Suppl 1) ◽

pp. i42-i49 ◽

Cited By ~ 8

Author(s):

A Berlinski ◽

M J Chambers ◽

L Willis ◽

K Homa ◽

G Com

Keyword(s):

Cystic Fibrosis ◽

National Recommendation ◽

Clinic Visits

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Adaptation of a mobile health platform to the needs of cystic fibrosis patients, caregivers, and clinicians in the United States (Preprint)

10.2196/preprints.19413 ◽

2020 ◽

Author(s):

Sarah B. Rutland ◽

Rikard Palmer Bergquist ◽

Andreas Hager ◽

Robin Geurs ◽

Cathy Mims ◽

...

Keyword(s):

United States ◽

Cystic Fibrosis ◽

Focus Groups ◽

Mobile Health ◽

Healthcare Providers ◽

The United States ◽

Standards Of Care ◽

Healthcare Team ◽

Daily Care ◽

Clinic Visits

BACKGROUND Cystic fibrosis (CF) is an inherited chronic condition that requires extensive daily care and quarterly clinic visits with a multidisciplinary care team. The limited exchange of information outside of the quarterly clinic visits impedes optimal disease self-management, patient engagement, and shared decision-making. OBJECTIVE This study adapted a mobile health (mHealth) application originally developed in Sweden to the needs of people with CF, their caregivers, and healthcare providers in the United States, and tested it as a platform for sharing patient-generated health data (PGHD) with the CF healthcare team. METHODS Focus groups with CF healthcare providers, adolescents with CF, and caregivers of children and adolescents with CF were conducted to determine what modifications were necessary. Focus group data were analyzed using a thematic analysis, and emergent themes were ranked according to desirability and technical feasibility. The mHealth platform was then modified to meet the identified needs and preferences, and the flow of PGHD to a secure REDCap database was tested. Protocols for data management and clinical follow-up were also developed. RESULTS Five focus groups with 21 participants were conducted. Recommended modifications pertained to all functionalities of the mHealth platform, including tracking of symptoms, treatments, and activities of daily care; creating and organizing medication lists and setting up reminders; generating reports for the healthcare team; language and presentation; sharing and privacy; as well as settings and accounts. Overall, healthcare providers recommended changes to align the mHealth platform with U.S. standards of care, people with CF and their caregivers requested to track more disease symptoms and clinical outcomes, and both groups suggested the inclusion of a mental health tracker as well as more detailed response options and precise language. Beta-testers of the modified platform reported issues related to translatability to U.S. environment and various bugs. CONCLUSIONS This study demonstrated the importance of identifying the needs and preferences of target users and stakeholders before adopting existing mHealth solutions. All relevant perspectives, including those of clinicians, patients, and caregivers, should be thoroughly considered in order to meet both end-user needs and evidence-based practice recommendations. CLINICALTRIAL NCT03910881

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Clinical Efficacy of Telemedicine Compared to Face-to-Face Clinic Visits for Smoking Cessation: Multicenter Open-Label Randomized Controlled Noninferiority Trial

Journal of Medical Internet Research ◽

10.2196/13520 ◽

2019 ◽

Vol 21 (4) ◽

pp. e13520 ◽

Cited By ~ 8

Author(s):

Akihiro Nomura ◽

Tomoyuki Tanigawa ◽

Tomoyasu Muto ◽

Takafumi Oga ◽

Yasushi Fukushima ◽

...

Keyword(s):

Smoking Cessation ◽

Clinical Efficacy ◽

Open Label ◽

Face To Face ◽

Randomized Controlled ◽

Noninferiority Trial ◽

Clinic Visits

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Emerging Alternatives to Conventional Clinic Visits in the Era of COVID-19: Adoption of Telehealth at VCU Adult Cystic Fibrosis Center

International Journal of General Medicine ◽

10.2147/ijgm.s274193 ◽

2020 ◽

Vol Volume 13 ◽

pp. 1175-1186

Author(s):

Caitlin Womack ◽

Ruhan Farsin ◽

Mahsa Farsad ◽

Nauman Chaudary

Keyword(s):

Cystic Fibrosis ◽

Clinic Visits

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Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

Applied Clinical Informatics ◽

10.4338/aci-2014-12-ra-0117 ◽

2015 ◽

Vol 06 (02) ◽

pp. 288-304 ◽

Cited By ~ 46

Author(s):

S.E. Davis ◽

J.A. Shenson ◽

Q. Chen ◽

S.T. Rosenbloom ◽

G.P. Jackson ◽

...

Keyword(s):

Health Care Providers ◽

Medical Center ◽

Patient Portal ◽

Care Providers ◽

Patient Portals ◽

Healthcare Organizations ◽

Secure Messaging ◽

Medical Specialties ◽

Face To Face ◽

Clinic Visits

SummaryObjective: Patient portals are online applications that allow patients to interact with healthcare organizations. Portal adoption is increasing, and secure messaging between patients and health-care providers is an emerging form of outpatient interaction. Research about portals and messaging has focused on medical specialties. We characterized adoption of secure messaging and the contribution of messaging to outpatient interactions across diverse clinical specialties after broad portal deployment.Methods: This retrospective cohort study at Vanderbilt University Medical Center examined use of patient-initiated secure messages and clinic visits in the three years following full deployment of a patient portal across adult and pediatric specialties. We measured the proportion of outpatient interactions (i.e., messages plus clinic visits) conducted through secure messaging by specialty over time. Generalized estimating equations measured the likelihood of message-based versus clinic outpatient interaction across clinical specialties.Results: Over the study period, 2,422,114 clinic visits occurred, and 82,159 unique portal users initiated 948,428 messages to 1,924 recipients. Medicine participated in the most message exchanges (742,454 messages; 78.3% of all messages sent), followed by surgery (84,001; 8.9%) and obstetrics/gynecology (53,424; 5.6%). The proportion of outpatient interaction through messaging increased from 12.9% in 2008 to 33.0% in 2009 and 39.8% in 2010 (p<0.001). Medicine had the highest proportion of outpatient interaction conducted through messaging in 2008 (23.3% of out-patient interactions in medicine). By 2010, this proportion was highest for obstetrics/gynecology (83.4%), dermatology (71.6%), and medicine (56.7%). Growth in likelihood of message-based interaction was greater for anesthesiology, dermatology, obstetrics/gynecology, pediatrics, and psychiatry than for medicine (p<0.001).Conclusions: This study demonstrates rapid adoption of secure messaging across diverse clinical specialties, with messaging interactions exceeding face-to-face clinic visits for some specialties. As patient portal and secure messaging adoption increase beyond medicine and primary care, research is needed to understand the implications for provider workload and patient care.Citation: Cronin RM, Davis SE, Shenson JA, Chen Q, Rosenbloom ST, Jackson GP. Growth of secure messaging through a patient portal as a form of outpatient interaction across clinical specialties. Appl Clin Inf 2015; 6: 288–304http://dx.doi.org/10.4338/ACI-2014-12-RA-0117

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Diabetes Mellitus Associated With Cystic Fibrosis: Applying American Diabetes Association Standards

PEDIATRICS ◽

10.1542/peds.87.5.749 ◽

1991 ◽

Vol 87 (5) ◽

pp. 749-749

Author(s):

JOE REISMAN

Keyword(s):

Diabetes Mellitus ◽

Cystic Fibrosis ◽

Glucose Metabolism ◽

Glucose Tolerance ◽

American Diabetes Association ◽

Clinical Symptoms ◽

Abnormal Glucose Metabolism ◽

Insulin Dependent ◽

Tolerance Testing ◽

Clinic Visits

In Reply.— John Sheehan and Margaret Ulchaker make several interesting points in their letter. They were critical of the fact that nondiabetic patients were not proven to be so by glucose tolerance testing. To test more than 530 patients regularly with such testing is not felt to be indicated or practical in our clinic. Although such testing may identify individuals with abnormal glucose metabolism, this manuscript was concerned with survival of insulin-dependent diabetics.1 Such patients when untreated will spill sugar in their urine, and/or exhibit other clinical symptoms, and thus be identified at their regular clinic visits.

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Pediatric Otolaryngology Telehealth in Response to COVID-19 Pandemic: Lessons Learned and Impact on the Future Management of Pediatric Patients

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420976163 ◽

2020 ◽

pp. 000348942097616

Author(s):

Ryan H. Belcher ◽

James Phillips ◽

Frank Virgin ◽

Jay Werkhaven ◽

Amy Whigham ◽

...

Keyword(s):

Medical Center ◽

The United States ◽

Lessons Learned ◽

Face To Face ◽

Pediatric Otolaryngology ◽

Institutional Review ◽

Time Period ◽

Significant Difference ◽

Interpretive Services ◽

Clinic Visits

Background: Since the start of the COVID-19 pandemic outpatient medicine has drastically been altered how it is delivered. This time period likely represents the largest volume of telehealth visits in the United States health care history. Telehealth presents unique challenges within each subspecialty, and pediatric otolaryngology is no different. This retrospective review was designed to evaluate our division of pediatric otolaryngology’s experience with telehealth during the COVID19 pandemic. Methods: This study was approved by the Institutional Review Board at Vanderbilt University Medical Center. All telehealth and face-to-face visits for the month of April 2020 completed by the Pediatric Otolaryngology Division were reviewed. A survey, utilizing both open-ended questions and Likert scaled questions was distributed to the 16 pediatric otolaryngology providers in our group to reflect their experience with telehealth during the 1-month study period. Results: In April, 2020 our outpatient clinic performed a total of 877 clinic visits compared to 2260 clinic visits in April 2019. A total of 769 (88%) were telehealth visits. Telemedicine with video comprised 523 (68%) and telephone only comprised 246 (32%). There were 0 telehealth visits in April 2019. Interpretive services were required in 9.3% (N = 211) clinic visits in April 2019 and 7.5% (N = 66) of clinic visits in April 2020. The survey demonstrated a significant difference ( P < .00002) in provider’s anticipated telehealth experience (mean 3.94, 95% CI [3.0632, 4.8118] compared to their actual experience after the study period (mean 7.5, 95% CI [7.113, 7.887]. Conclusions: Despite low initial expectations for telehealth, the majority of our providers felt after 1 month of use that telehealth would continue to be a valuable platform post-pandemic clinical practice. Limited physical exam, particularly otoscopy, nasal endoscopy, and nasolaryngoscopy present challenges. However, with adequate information and preparation for the parents and for the physician some of the obstacles can be overcome.

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Information needs of parents of infants diagnosed with cystic fibrosis: Results of a pilot study

Journal of Child Health Care ◽

10.1177/1367493518760734 ◽

2018 ◽

Vol 22 (3) ◽

pp. 382-392 ◽

Cited By ~ 3

Author(s):

Danielle J Edwards ◽

Kristin Wicking ◽

Wendy Smyth ◽

Linda Shields ◽

Tonia Douglas

Keyword(s):

Cystic Fibrosis ◽

Pilot Study ◽

Newborn Screening ◽

Negative Feedback ◽

Information Seeking ◽

Information Needs ◽

Response Rate ◽

The Internet ◽

Face To Face ◽

Education Experience

This study investigated the information needs, priorities and information-seeking behaviours of parents of infants recently diagnosed with cystic fibrosis (CF) following newborn screening, by piloting the ‘Care of Cystic Fibrosis Families Survey’. The questionnaires were posted to eligible parents ( n = 66) attending CF clinics in hospitals in two Australian states; reply-paid envelopes were provided for return of the questionnaires. Twenty-six were returned (response rate 39.4%). The most common questions to which parents required answers during their initial education period related to what CF is, how it is treated and how to care for their child. Parents preferred face-to-face consultations to deliver information, and yet all reported using the Internet to search for more information at some point during the education period. Many parents provided negative feedback about being given their child’s CF diagnosis via telephone. The timing, content and method of information delivery can all affect the initial education experience. We can deliver education to better suit the information needs and priorities for education of parents of infants recently diagnosed with CF. The Care of Cystic Fibrosis Families Survey was successfully piloted and recommendations for amendments have been made for use in a larger study across Australia.

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