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

Abstract

Cystic fibrosis (CF) is a genetic disease in which consistent follow-up care is required to avoid a decline in pulmonary and nutritional health. It is believed that if a CF patient ceases treatment for 2 days, this can result in an exacerbation. One week of missed treatments can result in a hospitalization and 1 month of missed treatments can result in an earlier demise. With a global pandemic that has affected more than 9 million people, many CF clinics were required to take steps to avoid transmission of this dangerous virus. This may result in delays in delivery of timely CF care due to closure of clinics and pulmonary function testing (PFT) laboratories and limited staff allowed on site for conducting in-person visits. These measures, along with suggestions from the Cystic Fibrosis Foundation (CFF) to extend the social distancing longer than traditional CDC recommendations for the CF community, create an urgent need to explore novel ways to deliver safer care via new standards in chronic health conditions like CF. Especially, as these preventive strategies may be necessary for long-term maintenance, few objective alternatives exist to guide clinicians and allied health professionals in CF centers how to proceed in this new era. This also presents an opportunity for novel approaches that could improve delivery of CF care with remote monitoring and real-time delivery of care in patients' home environments. Such emerging approaches could benefit patient care, leading to reduced costs and readmissions and improved access to care, medication adherence, and patient communication. We summarize our own experience and discuss the emerging delivery of CF care which can be generalizable to other pulmonary illnesses.

Keywords: COVID-19; coronavirus; cystic fibrosis; telehealth.

Figure 1

Pre-visit planning process. The process followed by cystic fibrosis care team members to schedule patients for virtual visits, set agenda in collaboration with the patients, and collaboratively prepare a plan of care prior to the clinic visit.

Figure 2

Virtual clinic flow chart. RT acts as a host for the Zoom visits, and creates breakout rooms for patients and a CF team room for CTMs. Each CTM meets with the patient in his/her breakout room for assessment and the last CTM checks out the patient from the clinic. Clinic flow is managed via clinic tracker and Microsoft Teams.

Figure 3

Home sputum and throat culture collection flow chart. Sputum culture is ordered by the MD. Nurse coordinator coordinates communication between the lab, the MD, and the Mayland clinic. Patient collects the sputum following instructions in the kit and sends it to the lab via FedEx.

Figure 4

Percentage of virtual visits completed by different care team members (CTMs) at VCU Adult CF Center between April 1 and June 30, 2020.