(366) Attitudes amidst the pandemic: virtual delivery of care in an adult cystic fibrosis population

Background: The COVID-19 pandemic has altered the way we deliver care to people with CF across all spectrums of disease severity. Due to lockdowns and the desire to avoid additional exposure to COVID-19 by limiting in-person clinic visits, clinical care has pivoted from standard practices to offer virtual care in combination with in-person traditional visits. This approach has allowed patients to be monitored and treated in a timely manner. Such virtual visits have the distinct advantage of reducing the time commitment for clinic visits as the patient does not have to travel to and from the hospital. However, virtual care lacks the ability to conduct a physical examination and to obtain objective and standardized testing of key measurements known to be associated with health outcomes in CF. The objective of this study was to evaluate the attitude and comfort level with virtual delivery of care from the patient’s perspective.

Methods: This is a prospective, cross-sectional survey of adults with CF who are followed at St. Michael’s Adult CF Center in Toronto, Canada. A newly developed online survey was created using SurveyMonkey to assess attitudes towards and satisfaction with virtual care. The survey was emailed to participants and included the Canadian CF Registry ID and a reminder follow-up email sent a week later. Baseline demographic and clinical data were obtained from the Canadian CF Registry. Data were presented as median (range) or proportions as appropriate. Questions using a 3 point Likert scale will be categorized into agree, neutral and disagree.

Results: A total of 210 participants (53.0% female) completed the survey with a median age of 37.8 years (19.2-78.9). The median age of diagnosis was 2.2 years, 95.7% were Caucasian, 76.0% had completed post-secondary education, 63.0% were currently employed and 11.0% were students, 75% were pancreatic insufficient, 39.0% had CF-related diabetes, and 12.4% were post lung-transplant. The median FEV1% predicted was 65.8% (17.9-126.9) and BMI was 23.6 kg/m² (15.5-45.7). The majority (81.0%) of respondents had experienced a virtual visit prior to completing the survey. Sixty percent of respondents felt that in-person visits were the preferred way of completing a medical assessment while only 27.0% felt virtual visits were preferred when being assessed. Seventy-three percent felt it was important for the virtual visit to occur at the booked time, 59.0% had concerns that their lung function was not assessed during virtual visits, 46.0% felt they were losing the benefits of allied health team assessments with virtual visits, and almost 40.0% worried that their health would decline if primarily seen virtually. Just over half of respondents wanted to continue with virtual visits in some capacity after the pandemic. The optimal proportion of in-person versus virtual visits was felt to be 50.0%. The majority of respondents ( >85.0%) were comfortable with technology (phone or computer) and had reliable access to the internet to conduct virtual visits. Seventy percent of people would like to have access to a home spirometer but cost was a barrier to using this technology.





Conclusions: From the patient’s perspective, in-person visits were still the preferred way to complete a medical assessment which seemed to be driven by concerns over lack of methods for assessment, particularly lung function, and easier access to the multi-disciplinary team. Home spirometers, if freely available, may increase the comfort level with virtual appointments.

Acknowledgements:

References: