The impact of telehealth on clinical outcomes in adults and children with cystic fibrosis in Australia

Abstract

BACKGROUND: Telehealth has been widely incorporated into cystic fibrosis (CF) care in Australia and other countries, with a largely hybrid approach of multidisciplinary telehealth alongside traditional in-person care. While feasibility and acceptability of telehealth-based care has been established, the impact on CF-related health outcomes has not been comprehensively assessed. METHODS: Retrospective cohort study using national Australian Cystic Fibrosis Registry Data (ACFDR). Primary outcomes were change in percent predicted forced expiratory volume in one second (ppFEV(1)) in adults and body mass index (BMI) z-score in children. Secondary outcomes included lung function, BMI, microbiology and hospital admissions. Telehealth use was stratified according to percentage of telehealth visits out of total CF clinic visits during the study period, examined as quartiles. Analyses were conducted using Analysis of Covariance (ANCOVA) and logistic regression, to isolate the effect of telehealth use quartile on outcomes after adjusting for confounders. RESULTS: Complete data from 1250 patients, (646 < 18 yr, 594 ≥ 18 yrs), were analysed. There was less decline in ppFEV(1) in adults (β = 6.06, p < 0.001), and lower detection of Pseudomonas aeruginosa in adults (OR = 0.419, p = 0.035) and children (OR = 0.182, p = 0.011) who received greater than 75% of visits via telehealth. However, high telehealth use was associated with reduced microbiological sampling. Telehealth was not associated with change in BMI or hospitalisations. CONCLUSIONS: Population level data from the ACFDR demonstrates that higher telehealth usage was not associated with adverse health outcomes and was associated with a reduced decline in ppFEV(1) in adults.