Cystic Fibrosis Health Outcomes Similar for Telehealth, In-Person Care

Using telehealth for cystic fibrosis treatment during the pandemic led to similar health outcomes for patients as in-person care, a study published in the journal Chest found.

When the COVID-19 pandemic hit in March 2020, the adult cystic fibrosis team at the University of Virginia started to include telehealth services in its care model.

In order to understand the impact of this transition, researchers compared clinical outcomes from the pandemic between March 17, 2020, and March 16, 2021, to outcomes from pre-pandemic patients, which were collected retrospectively from March 17, 2019, to March 16, 2020.

The health system contacted patients prior to their appointments for a pre-visit screening to determine if the patient qualified for a telehealth visit. Telehealth eligibility was based on clinical stability, patient preference, medical needs, and access to internet and proper technology.

The primary health outcome that the researchers focused on was lung function stability. Patients received a home spirometer from the clinic and virtual assistance from a respiratory therapist. Additional outcomes included pulmonary exacerbation rates, antibiotic use, and body mass index (BMI).

The researchers analyzed a total of 110 patients who received cystic fibrosis care during the pandemic. Among the patients, there were 407 clinical encounters. More than half of the visits (64 percent) were conducted via telehealth. Just over a quarter of the visits (28 percent) were hybrid visits in which the patient attended an in-person visit and received additional support via telehealth. Only 7 percent of the visits were entirely in-person.

After adjusting for elexacaftor-tezacaftor-ivacaftor (ETI) therapy use — a medication that helps manage cystic fibrosis — the researchers found that there was no significant difference in lung function between the pre-pandemic and pandemic-year patients.

Additionally, there was no significant difference in exacerbation rates between the two groups, with the pre-pandemic group seeing 0.065 exacerbations per person per year and the pandemic group seeing 0.054 exacerbations per person per year. During the pandemic study period, 64 percent of all exacerbations were diagnosed during hybrid or in-person visits, and 36 percent were diagnosed via telehealth, the researchers noted.

Antibiotic use was similar for telehealth and in-person patients as well, though it slightly decreased during the pandemic. The rate went from 0.612 per person per year during the pre-pandemic period to 0.366 per person per year during the pandemic.

According to the researchers, this suggests that social mitigation may help reduce overexposure to antibiotics. ETI therapy use may have also helped decrease antibiotic use.

BMI increased slightly for telehealth users, going from a mean of 25.2 pre-pandemic to 26.2 during the pandemic. Researchers attributed this to the introduction of ETI therapy and noted that quarantine-associated weight gain may have also influenced BMI changes.

When comparing in-person care to telehealth visits, the researchers found that clinical outcomes for cystic fibrosis treatment largely remained the same. This indicates that the virtual care model could be a successful alternative to the in-person model, with the inclusion of pre-visit screenings and home spirometry with proper education.

Past studies have highlighted the role of telehealth in other pulmonary conditions as well. For example, a study from Temple University Hospital researchers found that using telehealth for lung cancer screenings was just as effective as in-person screenings.

Additionally, researchers at the University of Alabama at Birmingham found that a telehealth platform helped providers reduce 30-day readmissions among patients who were hospitalized with chronic obstructive pulmonary disease (COPD).