(37) Trends in Canadian cystic fibrosis healthcare utilization amidst the COVID-19 pandemic

Background: The COVID-19 pandemic resulted in widespread changes in healthcare utilization for Canadians living with CF. The objective of this analysis is to describe the impact of the COVID-19 pandemic on the delivery of usual CF healthcare.

Methods: The Canadian Cystic Fibrosis Registry is a national repository of longitudinal data from 42 CF clinics across Canada. This study included data on clinic visits (including virtual and telemedicine), hospitalizations, home IV courses, and microbiology cultures recorded in the CF Registry from 2016 to 2020. Clinical measurements typically collected during clinic visits include height, weight, and lung function measured as FEV₁ percent predicted (ppFEV₁). Lung function is not typically measured in young children, therefore analyses on ppFEV₁ are restricted to individuals greater or equal to 6 years of age. Healthcare utilization is described as the proportion of individuals who have at least one recorded measurement or encounter in the reporting year.

Results: The number of clinic visits, hospitalizations, and home IV courses recorded monthly in the CF Registry remained relatively stable from 2016 to 2019, averaging 1528 clinic visits, 130 hospitalizations, and 81 home IV courses per month from 2016 to 2019. With the declaration of the COVID-19 pandemic in early March 2020, the overall number of CF healthcare encounters decreased substantially. Comparing the number of healthcare encounters recorded in April 2019 versus April 2020, there were 29.7% fewer clinic visits, 67.6% fewer pulmonary exacerbation (PEx) hospitalizations, and 39.6% fewer home IV courses. Looking at month-to-month changes in 2020, the trends in healthcare encounters appear to be inversely related to the number of COVID-19 cases recorded in Canada – while infection rates increased, CF healthcare utilization decreased. The proportion of individuals with at least one ppFEV1 measurement decreased from a mean of 97.0% (from 2016 to 2019) to 89.0% (in 2020), PEx hospitalizations decreased from a mean of 20.9% (from 2016 to 2019) to 14.8% (in 2020), and microbiology cultures (excluding COVID-19) decreased from a mean of 92.6% (from 2016 to 2019) to 85.4% (in 2020). It follows that the mean number of healthcare encounters (such as ppFEV1 and BMI measurements, clinic visits, and microbiology cultures) recorded per individual also decreased in 2020 compared to the past 4 years (Figure 1).

Conclusions: The reduced number of healthcare encounters for Canadians living with CF provides insight into the impact of COVID-19 on the delivery of CF care in 2020. The resulting lack of objective measurements typically assessed during clinic visits, such as lung function or new onset infections, may not be appreciated or recognized until later than usual. Coinciding with the COVID-19 pandemic, some Canadians with CF also became eligible for the-­ highly effective modulator therapy elexacaftor/tezacaftor/ivacaftor, which could be a confounding factor in the decreased number of clinic visits or hospitalizations. Disentangling the combined effects of these events on the delivery of CF care will be an important subject for future analysis.

Acknowledgements: We would like to acknowledge the involvement and continued participation of those living with cystic fibrosis who consent to having their data submitted, and the exceptional effort and contribution from CF clinic team members who collect and enter the data.

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