(64) Successful Creation of a Home Spirometry Program within an Adult CF Clinic

Background: Highly effective modulator therapy and the COVID-19 pandemic have transformed cystic fibrosis (CF) care. Increased use of telehealth has resulted in fewer in-person visits. However, close monitoring continues to be crucial in preventing complications. Home spirometry is a useful and accessible tool that CF patients can use to monitor their lung function. In Spring 2020, the UNC Adult CF Clinic began to distribute home spirometers to their patients through the Cystic Fibrosis Foundation (CFF). At the time, we lacked a standardized home spirometry program and found it challenging to engage patients in regular use of the device. As a result, the UNC Adult CF Advanced Practice Provider (APP) and Respiratory Therapist (RT) collaborated to lead a quality improvement (QI) project aimed at improving home spirometry at their center.

Methods: Goals of the QI effort were to provide individual education for all patients with a home spirometer, incorporate home spirometry assessments into the RT workflow, and provide monthly interpretation of home spirometry results. The CF RT utilized Epic MyChart messages to engage patients who needed education and to remind patients to use their device before all visits (virtual or face-to-face). In-person teaching and troubleshooting were also provided by the RT and APP in clinic, and an educational handout was created. Lastly, one-on-one education was provided by phone on non-clinic days. Between November 2021 and January 2022, CF patients who had received a device and adult CF clinicians were surveyed for anonymous feedback on the program. Survey questions utilized a 5-point Likert scale to indicate agreement with the survey statement and were adapted from a previous home spirometry survey in lung transplant patients [1].

Results: To date, 265 patients (out of 327 total adult CF patients at UNC) have received a home spirometer through the CFF or another source. Of these, 250 (94%) have received one-on-one education. All six adult CF clinicians completed the feedback survey. The results indicated a high level of satisfaction and sense that spirometer use was clinically useful (Figure 1). Seventy-eight (78) patients completed the feedback survey. Regarding the program’s utility, the following percentages of respondents agreed or strongly agreed with the following statements: spirometer is easy to use (81%), received adequate training (88%), spirometer is accurate (78%), team is interested in my results (96%), makes me feel secure in detecting problems with my lungs (60%), helpful to share results on the provider dashboard (68%), and am overall satisfied with the home spirometry program (78%).When patients were asked about barriers to use of their home spirometer, 48 patients (62%) selected “none.” The barriers that were most commonly identified (number of responses) included: anxiety (5), too difficult to use (4), too time-consuming (3), forgetfulness (3), and accuracy (2).

Conclusions: We were able to leverage the widespread availability of home spirometers to create a successful home spirometry program within the UNC Adult CF Clinic. Our survey results indicate that both clinicians and patients felt that home spirometry was useful and were highly satisfied with the current program.

Acknowledgements:

References: [1] Finkelstein SM, MacMahon K, Lindgren BR, et al. Development of a remote monitoring satisfaction survey and its use in a clinical trial with lung transplant recipients. J Telemed Telecare. 2012;18(1):42-46. doi:10.1258/jtt.2011.110413