Telehealth Finds Acceptance Among Patients With Cf, Clinicians

Jim Kling, MDedge News

November 23, 2020

Telehealth is widely accepted among individuals with cystic fibrosis (CF) and the physicians who treat them, according to three new studies. The surveys examined attitudes during the COVID-19 pandemic, which complicates interpretation of the survey, but the results nevertheless bode well for telehealth's future in the management of CF.

"Patients could be responding positively just because they could have a visit during the pandemic," said Andrew NeSmith, during a presentation of a survey of adults with CF at the virtual North American Cystic Fibrosis Conference. NeSmith is the clinical data coordinator at the University of Alabama at Birmingham Cystic Fibrosis Center.

Other posters at the conference examined attitudes among pediatric populations and treating physicians, with generally positive results, which has generated optimism that telehealth could become an important element of care after the pandemic fades. "This data suggests that telehealth could be integrated into routine follow-up care in the CF chronic care model," said NeSmith.

His team collected responses from 119 individuals at the University of Alabama at Birmingham; Boston Children's Hospital; Brigham and Women's Hospital, Boston; Virginia Commonwealth University, Richmond; and West Virginia University, Morgantown. A total of 28% had conducted a prior telehealth visit before the study; 92% of visits were conducted with a medical doctor. Only 13% reported experiencing difficulties with their first telehealth visit. Eighty-five percent rated convenience, and 77% rated their satisfaction with telehealth as "high." Most (92%) said they were able to see their desired disciplines, 95% felt all of their issues had been addressed, and 83% strongly agreed that telehealth visits were of adequate length.

Not everything was rosy. A total of 48% of participants expressed at least moderate concern over a lack of pulmonary function test or throat/sputum culture. There were much fewer concerns over missing vital signs or weight measurements.

The overall results weren't surprising to Robert Giusti, MD, clinical professor of pediatrics at New York University and director of the Pediatric Cystic Fibrosis Center, New York, who was not involved in the study. "I was expecting that patients were going to like it. It makes their life easier," he said in an interview.

A survey of families of pediatric individuals with CF at seven centers found similar levels of satisfaction. A total of 23% had used telehealth previously; 96% rated convenience, and 93% rated satisfaction as "high." Almost all (99%) felt that all concerns were met, 98% said that sessions were adequately long, and 87% had no trouble connecting to the visit.

Some participants in this survey had concerns about what might be missing with a televisit. Half (52%) had at least a moderate concern over lack of pulmonary function tests, 45% over lack of vital signs, 29% about lack of weight measurements, and 64% about the need for throat/sputum culture. Despite those issues, 69% preferred that "some" and 22% preferred that "most" future visits be conducted by telehealth.

A survey of physicians who used telehealth with CF patients also found broad support. They reported some challenges, with 70% saying they experienced technical difficulty, and 77% saying it "took time" to resolve a visit with only 18% reporting that visits were "quickly resolved." Most (86%) said they were satisfied with telehealth for care delivery, and 78% said it was appropriate for most patients. Most said telehealth improved the patient-physician relationship, and they believed visits were more efficient when conducted via telehealth than in person. A majority (81%) endorsed using telehealth for some visits, and 12% for most visits.

A key question will be how telehealth affects patient outcomes, according to Ryan Perkins, MD, who was a coauthor of the survey of physicians. "If they're not doing as well from an outcomes perspective, that would be a huge limitation to our patients," said Perkins, who is a pediatric and adult pulmonary fellow at Boston Children's Hospital and Brigham and Women's Hospital.

Although the study examined only models of care that were entirely virtual, Perkins noted that hybrid in-person/virtual care models are also possible. "Do we have better outcomes doing it that way? Is there higher patient satisfaction? I'm sure that will be a hot topic moving forward."

Perkins noted that patients expressed concern about not being able to get sputum cultures and spirometry recordings during telehealth sessions. "That's not really surprising to me, but I think it raises the question as we're imagining care models for the future – how can we implement those components into future care delivery?"

Another hurdle will be insurance coverage. "My fear is that insurance companies are going to cut down the amount of reimbursement for telehealth visits in the future and just going to make it more complicated," said Giusti. "Certainly, though, I think telehealth is an important outreach that we'd like to continue with our patients."

NeSmith, Giusti, and Perkins reported no relevant financial disclosures.

SOURCE: NeSmith A et al. NACFC 2020, Abstracts 797, 799, 810.

This article originally appeared in Chest Physician.


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