Implementation of a Virtual Visit Protocol to Improve Clinic Visit Adherence of Pediatric Cystic Fibrosis Patients

Abstract

Background:

The COVID-19 pandemic greatly challenged how medical care is practiced. Many institutions initiated virtual visits (VV) for out-patient type appointments. In our cystic fibrosis (CF) clinic we hypothesized that adherence to quarterly visits might be improved through offering VV along with home spirometry (HS). HS was offered with or without virtual coaching sessions.

Methods:

Using the DMAIC method of quality improvement, we implemented HS as part of a VV protocol. Patients were able to use HS autonomously or with virtual coaching. Baseline data was collected in 2019. All patients within our Mayo CF Center age 6 to 18 years old as of 1/1/2019 were included. In 2020, we implemented a VV protocol consisting of a multidisciplinary care team VV with or without HS coaching. Patients could choose either virtual or in-person visits. Post-intervention data was collected in 2020 and 2021. Visit adherence was met if the patient attended at least 4 visits in one year and had at least 2 spirometry sessions (home or in lab).

Results:

In the group with HS (n = 19) compared to no HS (n = 7), there was no difference in age (n: 19 vs 7; P = .66), sex (F with = 6 [32], F without = 3 [43], P = .178), F508 homozygosity (n [%]: homozygous with = 10 [53], homozygous without = 1 [14], P = .178), pancreatic insufficiency (n[%]: insufficiency with = 15[53], insufficiency without 3 [43], P = .1490, distance of their home from the CF center (n [%]: more than 20 miles with = 12 [63], more than 20 miles without = 4 [67], P > .99), COVID infection (n [%]: infection with = 15 [79], infection without = 4 [57], P = .34), or modulator therapy (n [%]: >6 months modulator therapy and with = 16 [84], >6 months modulator therapy and without = 5 [71], P = .588). In 2021, in those with HS compared to those without, there was no significant difference in adherence (HS 37% adherence vs no HS 28% adherence; P = .6942; CI -0.3161, 0.4815) and no significant improvement in FEV₁ (HS and FEV₁ improvement 47% vs no HS and FEV₁ improvement 40%; P = .77, CI -0.41, 0.56). There was no significant association between number of HS coaching sessions and adherence (P = 0.7).

Conclusions:

Implementation of VV and HS failed to improve pediatric CF patients’ adherence to quarterly clinic visits and pulmonary function testing (PFT). We think these results are confounded by COVID-19 pandemic. We also think new highly effective modulator therapy has affected patient adherence to clinic visits and PFTs due to clinical improvement.