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Kelleher J, Durkin K, Fedele DA, Moffett K, Filigno SS, Lynn C, Everhart RS, Stark LJ, Duncan CL. Giving adolescents with cystic fibrosis a voice: Predicting cystic fibrosis nutritional adherence from their decision-making involvement. J Pediatr Psychol 2024; 49:491-500. [PMID: 38752579 PMCID: PMC11258803 DOI: 10.1093/jpepsy/jsae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVE Suboptimal nutritional adherence in adolescents with cystic fibrosis (awCF) has been associated with lower lung function. AwCF often have more independence in dietary decisions than younger children, yet little research has examined how adolescent decision-making relates to nutritional adherence. This study explored whether components of adolescent decision-making involvement facilitate enzyme and caloric adherence in awCF. METHODS 37 families participated and completed study procedures. AwCF and caregivers completed electronic surveys, including the Decision-Making Involvement Scale (DMIS). The DMIS evaluated awCF behaviors during nutrition-related decision-making/discussions with caregivers using DMIS subscales: Child Seek (asking for help/advice from caregivers), Child Express (awCF stating opinions) and Joint/Options (awCF participating in joint decision-making or caregiver providing options). AwCF completed 2, 24-hr diet recalls via videoconferencing/phone to estimate adherence. Chart reviews collected medical information. DMIS subscales were regressed onto enzyme and caloric adherence. RESULTS 43% of awCF met calorie recommendations; 48.6% took all enzymes as prescribed. Caloric adherence was positively correlated with adolescent- and parent-reported Child Seek (r = 0.53; r = 0.36) and adolescent-reported Joint/Options (r = 0.41). Per adolescent-report, the caloric adherence regression model was significant, with Child Seek contributing unique variance in caloric adherence (β = .62, p = .03). Parent-reported adolescent-decision-making involvement significantly predicted caloric adherence, but none of the subscales contributed unique variance. No other regressions were significant. CONCLUSIONS When awCF participated in nutrition-related discussions with a caregiver, especially with questions, caloric adherence was better. Future research should examine whether family factors influence these results. AwCF are encouraged to ask questions in nutrition discussions.
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Affiliation(s)
- Jennifer Kelleher
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Kristine Durkin
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, United States
| | - Kathryn Moffett
- Department of Pediatrics, West Virginia University Health Sciences Center, Morgantown, WV, United States
| | - Stephanie S Filigno
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Courtney Lynn
- Pediatric Mental Health Institute, Children’s Hospital Colorado, Aurora, CO, United States
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Lori J Stark
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, WV, United States
- Department of Pediatrics, West Virginia University Health Sciences Center, Morgantown, WV, United States
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2
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Eaton CK, McWilliams E, Yablon D, Kesim I, Ge R, Mirus K, Sconiers T, Donkoh A, Lawrence M, George C, Morrison ML, Muther E, Oates GR, Sathe M, Sawicki GS, Snell C, Riekert K. Cross-Cutting mHealth Behavior Change Techniques to Support Treatment Adherence and Self-Management of Complex Medical Conditions: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e49024. [PMID: 38717433 PMCID: PMC11085043 DOI: 10.2196/49024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/26/2024] [Accepted: 02/26/2024] [Indexed: 05/12/2024] Open
Abstract
Background Mobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management-promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions. Objective This study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands. Methods A registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form. Results A total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23%), asthma (27/122, 22%), and type 1 diabetes (19/122, 16%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P=.02). The following BCTs were associated with positive outcomes: self-monitoring outcomes of behavior (39/59, 66%), feedback on outcomes of behavior (34/59, 58%), self-monitoring of behavior (34/59, 58%), feedback on behavior (29/59, 49%), credible source (24/59, 41%), and goal setting (behavior; 14/59, 24%). In adult-only samples, prompts and cues were associated with positive outcomes (34/45, 76%). In adolescent and young adult samples, information about health consequences (1/4, 25%), problem-solving (1/4, 25%), and material reward (behavior; 2/4, 50%) were associated with positive outcomes. In interventions explicitly targeting medicine taking, prompts and cues (25/33, 76%) and credible source (13/33, 39%) were associated with positive outcomes. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior (8/26, 31%), goal setting (behavior; 8/26, 31%), and action planning (5/26, 19%) were associated with positive outcomes. Conclusions To support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools.
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Affiliation(s)
- Cyd K Eaton
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Emma McWilliams
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Dana Yablon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Irem Kesim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Renee Ge
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Karissa Mirus
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Takeera Sconiers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Alfred Donkoh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Melanie Lawrence
- Success with Therapies Research Consortium CF Community Member Advisory Board, Bethesda, MD, United States
| | | | - Mary Leigh Morrison
- Success with Therapies Research Consortium CF Community Member Advisory Board, Bethesda, MD, United States
| | - Emily Muther
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Gabriela R Oates
- Division of Pediatric Pulmonary & Sleep Medicine, Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Meghana Sathe
- Children’s Health Dallas, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gregory S Sawicki
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Carolyn Snell
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Kristin Riekert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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3
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Jones M, Moffatt F, Harvey A, Ryan JM. Interventions for improving adherence to airway clearance treatment and exercise in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 7:CD013610. [PMID: 37462324 PMCID: PMC10353490 DOI: 10.1002/14651858.cd013610.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-limiting genetic disorder predominantly affecting the lungs and pancreas. Airway clearance techniques (ACTs) and exercise therapy are key components of physiotherapy, which is considered integral in managing CF; however, low adherence is well-documented. Poor physiotherapy adherence may lead to repeated respiratory infections, reduced exercise tolerance, breathlessness, reduced quality of life, malaise and reduced life expectancy, as well as increased use of pharmacology, healthcare access and hospital admission. Therefore, evidence-based strategies to inform clinical practice and improve adherence to physiotherapy may improve quality of life and reduce treatment burden. OBJECTIVES To assess the effects of interventions to enhance adherence to airway clearance treatment and exercise therapy in people with CF and their effects on health outcomes, such as pulmonary exacerbations, exercise capacity and health-related quality of life. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 1 March 2023. We also searched online trials registries and the reference lists of relevant articles and reviews. Date of last search: 28 March 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of parallel design assessing any intervention aimed at enhancing adherence to physiotherapy in people with CF versus no intervention, another intervention or usual care. DATA COLLECTION AND ANALYSIS Two review authors independently checked search results for eligible studies and independently extracted data. We used standard procedures recommended by Cochrane and assessed the certainty of evidence using the GRADE system. MAIN RESULTS Two RCTs (77 participants with CF; age range 2 to 20 years; 44 (57%) males) met the inclusion criteria of this review. One study employed an intervention to improve adherence to exercise and the second an intervention to improve adherence to ACT. Both studies measured outcomes at baseline and at three months, but neither study formally assessed our primary outcome of adherence in terms of our planned outcome measures, and results were dependent on self-reported data. Adherence to ACTs One RCT (43 participants) assessed using specifically-composed music alongside ACTs compared to self-selected or no music (usual care). The ACT process consisted of nebuliser inhalation treatment, ACTs and relaxation or antibiotic nebuliser treatment. We graded all evidence as very low certainty. This study reported adherence to ACTs using the Morisky-Green questionnaire and also participants' perception of treatment time and enjoyment, which may influence adherence (outcome not reported specifically in this review). We are uncertain whether participants who received specifically-composed music may be more likely to adhere at six and 12 weeks compared to those who received usual care, risk ratio (RR) 1.75 (95% confidence interval (CI) 1.07 to 2.86) and RR 1.56 (95% CI 1.01 to 2.40) respectively. There may not be any difference in adherence when comparing specifically-composed music to self-selected music at six weeks, RR 1.21 (95% CI 0.87 to 1.68) or 12 weeks, RR 1.52 (95% CI 0.97 to 2.38); or self-selected music to usual care at six weeks, RR 1.44 (95% CI 0.82 to 2.52) or 12 weeks, RR 1.03 (95% CI 0.57 to 1.86). The music study also reported the number of respiratory infections requiring hospitalisation at 12 weeks, with no difference seen in the risk of hospitalisation between all groups. Adherence to exercise One RCT (24 participants) compared the provision of a manual of aerobic exercises, recommended exercise prescription plus two-weekly follow-up phone calls to reinforce exercise practice over a period of three months to verbal instructions for aerobic exercise according to the CF centre's protocol. We graded all evidence as very low certainty. We are uncertain whether an educational intervention leads to more participants in the intervention group undertaking increased regular physical activity at three months (self-report), RR 3.67 (95% CI 1.24 to 10.85), and there was no reported difference between groups in the number undertaking physical activity three times per week or undertaking at least 40 minutes of physical activity. No effect was seen on secondary outcome measures of spirometry, exercise capacity or any CF quality of life domains. This study did not report on the frequency of respiratory infections (hospitalised or not) or adverse events. AUTHORS' CONCLUSIONS We are uncertain whether a music-based motivational intervention may increase adherence to ACTs or affect the risk of hospitalisation for a respiratory infection. We are also uncertain whether an educational intervention increases adherence to exercise or reduces the frequency of respiratory infection-related hospital admission. However, these results are largely based on self-reported data and the impact of strategies to improve adherence to ACT and exercise in children and adolescents with stable CF remains inconclusive. Given that adherence to ACT and exercise therapy are fundamental to the clinical management of people with CF, there is an urgent need for well-designed, large-scale clinical trials in this area, which should conform to the CONSORT statement for standards of reporting and use appropriate, validated outcome measures. Studies should also ensure full disclosure of data for all important clinical outcomes.
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Affiliation(s)
- Mandy Jones
- c/o Cochrane Cystic Fibrosis, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alex Harvey
- School of Health Sciences and Social Care, Brunel University London, Uxbridge, UK
| | - Jennifer M Ryan
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Nadeau JM, Tan SY. Considerations for intensive treatment programs among youth with medical and behavioral health concerns. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2106986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Sim Yin Tan
- Rogers Behavioral Health, Outpatient Services, Tampa, FL, USA
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5
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Lynn C, Lyons E, Muther E. Delivery of cystic fibrosis psychosocial care across developmental stages. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1993228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Courtney Lynn
- Department of Psychiatry, University of Colorado School of Medicine
- Children’s Hospital Colorado, Pediatric Mental Health Institute
| | - Emma Lyons
- Children’s Hospital Colorado, Pediatric Mental Health Institute
| | - Emily Muther
- Department of Psychiatry, University of Colorado School of Medicine
- Children’s Hospital Colorado, Pediatric Mental Health Institute
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6
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Perkins RC, Gross R, Regan K, Bishay L, Sawicki GS. Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study. JMIR Pediatr Parent 2021; 4:e25014. [PMID: 34232121 PMCID: PMC8406102 DOI: 10.2196/25014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/02/2021] [Accepted: 07/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND For individuals with cystic fibrosis (CF), adolescence and young adulthood are times of significant vulnerability and have been associated with clinical and psychosocial challenges. Social media may offer innovative care delivery solutions to address these challenges. OBJECTIVE This study explored motivations and attitudes regarding current social media use and preferences for a social media platform in a sample of adolescents and young adults (AYA) with CF. METHODS A cross-sectional survey was administered to 50 AYA with CF followed at a large pediatric-adult CF center. The survey included questions regarding social media platform utilization, attitudes toward general and CF-specific online activities, and preferences for a CF-specific care delivery platform. RESULTS YouTube, Snapchat, and Instagram were the most commonly used social media platforms. AYA with CF do not report routinely using social media for health-related information acquisition, social support, or help with adherence. However, their perceptions of social media utilization and preferences for platform development suggest interest in doing so in the future. CONCLUSIONS AYA with CF use social media and expressed interest in the development of a social media platform. Platform development will allow for gaps in health care delivery to be addressed by improving social support and adherence while augmenting current methods of health information acquisition.
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Affiliation(s)
- Ryan C Perkins
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Rachel Gross
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Kayla Regan
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Lara Bishay
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, United States
| | - Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States
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7
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Chadwick HK, Abbott J, Hurley MA, Dye L, Lawton CL, Mansfield MW, Peckham D. Cystic fibrosis-related diabetes (CFRD) and cognitive function in adults with cystic fibrosis. J Cyst Fibros 2021; 21:519-528. [PMID: 34134937 DOI: 10.1016/j.jcf.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/15/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Being able to function cognitively is imperative for successful achievement in school, working life, and disease self-management. Diabetes is known to cause changes in brain structure and long-term cognitive dysfunction. This work investigated cystic fibrosis-related diabetes (CFRD) as a mechanism for cognitive impairment in people with CF. It was hypothesised that cognition would be poorer in adults with CFRD than in those with CF without diabetes (CFND) or in healthy controls. METHODS Cognitive performance was assessed using the Cambridge Neuropsychological Test Automated Battery which provides a comprehensive cognitive assessment with tests mapping onto specific brain regions. Demographic, clinical and self-reported health data were documented for all participants. CF specific clinical variables were recorded for the two CF groups. RESULTS Ninety-eight people with CF (49CFRD,49CFND) and 49 healthy controls were recruited. People with CF demonstrated deficits in aspects of verbal and spatial memory, processing speed and cognitive flexibility compared with healthy controls, with all areas of the brain implicated. Those with CFRD had additional difficulties with higher-level processes known collectively as 'executive function', which demand greater cognitive load and recruit the prefrontal cortex. Compared with healthy controls, those with CFND and CFRD had an estimated 20% and up to 40% reduction in processing speed respectively. CONCLUSION Managing CF requires higher order executive function. Impairments may be sufficient to interfere with self-care and the ability to perform everyday tasks efficiently. At which point in the CF disease trajectory these difficulties begin, and what may attenuate them, has yet to be determined.
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Affiliation(s)
- Helen K Chadwick
- School of Psychology, University of Leeds, Leeds LS2 9JT, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds LS2 9JT, UK; Adult Cystic Fibrosis Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK.
| | - Janice Abbott
- School of Psychology, University of Central Lancashire, Preston PR1 2HE, UK
| | - Margaret Anne Hurley
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - Clare L Lawton
- School of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - Michael W Mansfield
- Leeds Centre for Diabetes and Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | - Daniel Peckham
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds LS2 9JT, UK; Adult Cystic Fibrosis Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
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8
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Perkins RC, Shah M, Sawicki GS. An evaluation of healthcare utilization and clinical charges in children and adults with cystic fibrosis. Pediatr Pulmonol 2021; 56:928-938. [PMID: 33621440 DOI: 10.1002/ppul.25251] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prior studies have estimated healthcare costs for cystic fibrosis (CF) of $8000-$131,000, but do not account for impacts of CF modulator therapy. This study aims to assess utilization patterns and cost of CF care in a center in the United States. METHODS Care utilization patterns and costs at a large pediatric-adult CF center were examined from November 2017 to November 2018. Subjects were stratified by age and cost (excluding pharmacy costs) were calculated based on hospital-derived utilization charges. RESULTS A total of 166 patients were reviewed with mean clinical charges of $28,755. Lower lung function ($23,032 normal lung function, $62,293 moderate reduction, $186,786 severe reduction; p = .05), hospitalizations ($85,452 yes, $6362 no; p = .0001), Pseudomonas positive culture ($48,660 positive, $22,013 negative, p = .0001), and CF-related diabetes ($161,892 CFRD, $22,153 no CFRD; p = .001) were associated with increased charges. Patients utilizing Ivacaftor had lower charges compared to lumacaftor-ivacaftor ($6633 vs. $33,039; p = .05) and tezacaftor-ivacaftor ($6633 vs. $64,434; p = .002). CONCLUSION Our study characterized utilization and care charges among a CF cohort. Lower lung function, hospitalizations, and CFRD were associated with increased charges.
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Affiliation(s)
- Ryan C Perkins
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mahek Shah
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, Massachusetts, USA
| | - Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Thee S, Stahl M, Fischer R, Sutharsan S, Ballmann M, Müller A, Lorenz D, Urbanski-Rini D, Püschner F, Amelung VE, Fuchs C, Mall MA. A multi-centre, randomized, controlled trial on coaching and telemonitoring in patients with cystic fibrosis: conneCT CF. BMC Pulm Med 2021; 21:131. [PMID: 33882893 PMCID: PMC8058751 DOI: 10.1186/s12890-021-01500-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background The extend of lung disease remains the most important prognostic factor for survival in patients with cystic fibrosis (CF), and lack of adherence is the main reason for treatment failure. Early detection of deterioration in lung function and optimising adherence are therefore crucial in CF care. We implement a randomized controlled trial to evaluate efficacy of telemonitoring of adherence, lung function, and health condition in combination with behavior change interventions using innovative digital technologies. Methods This is a multi-centre, randomized, controlled, non-blinded trial aiming to include 402 patients ≥ 12 years-of-age with CF. A standard-of-care arm is compared to an arm receiving objective, continuous monitoring of adherence to inhalation therapies, weekly home spirometry using electronic devices with data transmission to patients and caring physicians combined with video-conferencing, a self-management app and professional telephone coaching. The duration of the intervention phase is 18 months. The primary endpoint is time to the first protocol-defined pulmonary exacerbation. Secondary outcome measures include number of and time between pulmonary exacerbations, adherence to inhalation therapy, changes in forced expiratory volume in 1 s from baseline, number of hospital admissions, and changes in health-related quality of life. CF-associated medical treatment and care, and health care related costs will be assessed by explorative analysis in both arms. Discussion This study offers the opportunity to evaluate the effect of adherence interventions using telemedicine capable devices on adherence and lung health, possibly paving the way for implementation of telemedicine in routine care for patients with CF. Trial registration: This study has been registered with the German Clinical Trials Register (Identifier: DRKS00024642, date of registration 01 Mar 2021, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024642). Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01500-y.
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Affiliation(s)
- Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Lung Research (DZL), Associated Partner, Berlin, Germany
| | | | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, Division of Cystic Fibrosis, University Medicine Essen -Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Manfred Ballmann
- Department of Pediatrics, University Medicine Rostock, Rostock, Germany
| | | | | | | | - Franziska Püschner
- Private Institute for Applied Health Services Research (Inav) GmbH, Berlin, Germany
| | - Volker Eric Amelung
- Private Institute for Applied Health Services Research (Inav) GmbH, Berlin, Germany
| | | | - Marcus Alexander Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,German Centre for Lung Research (DZL), Associated Partner, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany.
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10
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Sepahzad A, Morris-Rosendahl DJ, Davies JC. Cystic Fibrosis Lung Disease Modifiers and Their Relevance in the New Era of Precision Medicine. Genes (Basel) 2021; 12:genes12040562. [PMID: 33924524 PMCID: PMC8069009 DOI: 10.3390/genes12040562] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
Our understanding of cystic fibrosis (CF) has grown exponentially since the discovery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene in 1989. With evolving genetic and genomic tools, we have come to better understand the role of CFTR genotypes in the pathophysiology of the disease. This, in turn, has paved the way for the development of modulator therapies targeted at mutations in the CFTR, which are arguably one of the greatest advances in the treatment of CF. These modulator therapies, however, do not target all the mutations in CFTR that are seen in patients with CF and, furthermore, a variation in response is seen in patients with the same genotype who are taking modulator therapies. There is growing evidence to support the role of non-CFTR modifiers, both genetic and environmental, in determining the variation seen in CF morbidity and mortality and also in the response to existing therapies. This review focusses on key findings from studies using candidate gene and genome-wide approaches to identify CF modifier genes of lung disease in cystic fibrosis and considers the interaction between modifiers and the response to modulator therapies. As the use of modulator therapies expands and we gain data around outcomes, it will be of great interest to investigate this interaction further. Going forward, it will also be crucial to better understand the relative influence of genomic versus environmental factors. With this understanding, we can truly begin to deliver personalised care by better profiling the likely disease phenotype for each patient and their response to treatment.
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Affiliation(s)
- Afsoon Sepahzad
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield Hospitals, London SW3 6NP, UK;
| | | | - Jane C. Davies
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield Hospitals, London SW3 6NP, UK;
- National Heart & Lung Institute, Imperial College London, Emmanuel Kay Building, 1b Manresa Rd, London SW3 6LR, UK
- Correspondence:
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Mehta Z, Kamal KM, Miller R, Covvey JR, Giannetti V. Adherence to cystic fibrosis transmembrane conductance regulator (CFTR) modulators: analysis of a national specialty pharmacy database. J Drug Assess 2021; 10:62-67. [PMID: 33968464 PMCID: PMC8078929 DOI: 10.1080/21556660.2021.1912352] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There have been significant advances in Cystic Fibrosis (CF) treatment, with the introduction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators. Adherence is an important goal for CF management, as nonadherence is linked to poor health outcomes. OBJECTIVE To calculate the medication adherence in patients taking CFTR modulators using a national specialty pharmacy database. METHODS This retrospective observational cohort study utilized de-identified specialty pharmacy data from September 2017 to August 2018 to assess medication adherence for three CFTR modulators: ivacaftor, lumacaftor/ivacaftor, and tezacaftor/ivacaftor & ivacaftor. The primary outcome was proportion of days covered (PDC) for each medication, with mean PDC values compared across age groups and insurance characteristics. All analyses were performed using the SAS 9.4 University Edition (SAS Institute, Cary, NC). RESULTS A total of 2,548 patients were analyzed, including 1,289 (50.59%) patients on lumacaftor/ivacaftor, 784 (30.77%) on ivacaftor, and 475 (18.64%) on tezacaftor/ivacaftor & ivacaftor. The mean PDC value for all CFTR modulators was above 0.80. Tezacaftor/ivacaftor & ivacaftor had the highest overall PDC of 0.92, while PDC values for both lumacaftor/ivacaftor and ivacaftor were 0.84. Children/adolescents on lumacaftor/ivacaftor (p = 0.0001) and tezacaftor/ivacaftor & ivacaftor (p = 0.001) had significantly higher mean PDC values compared to adults but not for ivacaftor (p = 0.3744). No statistical differences were seen in PDC across insurance characteristics. CONCLUSION To the best of our knowledge, this is the first study to assess the adherence of three CFTR modulators using a large nationwide specialty database. With high acquisition costs of CFTR modulator therapies, there is a need to improve rates of adherence in patients with CF.
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Affiliation(s)
- Zumi Mehta
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Khalid M. Kamal
- Department of Pharmaceutical Systems and Policy, Health Sciences Center, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | | | - Jordan R. Covvey
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Vincent Giannetti
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
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12
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Rogers J, Reed MP, Blaine K, Manning H. Children with medical complexity: A concept analysis. Nurs Forum 2021; 56:676-683. [PMID: 33625740 DOI: 10.1111/nuf.12559] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 01/01/2021] [Accepted: 01/29/2021] [Indexed: 11/27/2022]
Abstract
AIM The aim of this paper is to conduct a concept analysis on the term, "children with medical complexity." BACKGROUND Children with medical complexity (CMC) describes pediatric patients with chronic, sustained acuity; however, there is a lack of consensus in the literature regarding its exact meaning, characteristics, and implications. DESIGN This analysis relied upon the framework described by Walker and Avant. DATA SOURCE The CINAHL, MEDLINE, and PubMed databases were queried from April 2020 to December 2020 with an initial search of the literature for the keyword, "children with medical complexity" and other associated terms, such as "pediatric medical complexity" and "nursing care of children with medical complexity." REVIEW METHODS This analysis will explore the concept of CMC and its significance, attributes, antecedents, and consequences. RESULTS This investigation revealed that CMC are a growing population of pediatric patients who have one or more complex chronic conditions that affect multiple body systems, experience functional limitations, require extensive care coordination from multiple providers, and are dependent upon life-sustaining medical technology. CONCLUSIONS The findings can serve as a foundation for future work advancing the understanding of the topic of CMC.
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Affiliation(s)
- Jayne Rogers
- Medical Nursing Service, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mary P Reed
- Medical Nursing Service, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin Blaine
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Haylee Manning
- Medical Nursing Service, Boston Children's Hospital, Boston, Massachusetts, USA
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13
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Schneider M, Simpson J, Zlomke K. A comparison study: caregiver functioning and family resilience among families of children with cystic fibrosis, asthma, and healthy controls. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1842207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Mallory Schneider
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | - Jessica Simpson
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | - Kimberly Zlomke
- Department of Psychology, University of South Alabama, Mobile, AL, USA
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14
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Kern-Goldberger AS, Hill-Ricciuti AC, Zhou JJ, Savant AP, Rugg L, Dozor AJ, Welter J, Saiman L, Quittell LM. Perceptions of safety monitoring in CF clinical studies and potential impact on future study participation. J Cyst Fibros 2020; 18:530-535. [PMID: 31151855 DOI: 10.1016/j.jcf.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Individuals with CF and their parents cite safety concerns as barriers to participating in clinical studies. We assessed whether a brochure/infographic describing patient safety monitoring processes could reduce knowledge and attitude barriers regarding safety monitoring. We also identified factors associated with likely participation in future CF studies. METHODS Respondents from three CF centers in the U.S. were randomly assigned to receive the safety monitoring brochure/infographic or an unrelated brochure. Fifty parents of children with CF <16, 50 adolescents with CF 16-21, and 50 adults with CF ≥22 years old were recruited to complete the study survey. Factors associated with survey responses and with reported likelihood of participating in future studies were assessed. RESULTS Overall the safety monitoring brochure/infographic was associated with increased likelihood of future participation in non-drug studies (aOR 2.30, CI95 1.01-5.28), but not in drug studies. Non-Hispanic respondents reported greater likelihood of participating in a future drug study than Hispanic respondents (aOR 3.18, CI95 1.30-7.74). Adults with CF (aOR 2.62, CI95 1.05-6.51) and parents (aOR 4.49, CI95 1.66-12.15) were more likely than adolescents to report they would ask their care team about clinical trials. Confidence in safety monitoring was associated with reported likelihood of future participation in drug studies. CONCLUSIONS Potential future participation in CF drug and/or non-drug studies was associated with respondent age and ethnicity, receiving the safety monitoring brochure/infographic, and confidence in safety monitoring. Our findings underscore the need for education about safety monitoring, with targeted approaches for the Hispanic CF population and adolescents.
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Affiliation(s)
| | | | - Juyan J Zhou
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Adrienne P Savant
- Division of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Larissa Rugg
- Division of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Allen J Dozor
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - John Welter
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Lynne M Quittell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA.
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15
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Eaton CK, Beachy S, McLean KA, Nicolais CJ, Bernstein R, Sáez-Clarke E, Quittner AL, Riekert KA. Misunderstandings, misperceptions, and missed opportunities: Perspectives on adherence barriers from people with CF, caregivers, and CF team members. PATIENT EDUCATION AND COUNSELING 2020; 103:1587-1594. [PMID: 32098744 DOI: 10.1016/j.pec.2020.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/24/2020] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify differences in perspectives of people with cystic fibrosis (PwCF) and caregivers versus healthcare providers on adherence barriers. Mismatched perspectives may lead to miscommunication and missed opportunities to reduce barriers and improve CF outcomes. METHODS PwCF, caregivers, and CF providers completed audio-taped, semi-structured interviews about adherence barriers. Interviews were transcribed and coded for themes. Themes were reviewed to identify when PwCF-caregiver perspectives differed from providers'. RESULTS Participants included 14 adolescents with CF (mean age = 15.89 years, 64 % female, 71 % Caucasian), 14 adults with CF (mean age = 30.03 years, 64 % female, 57 % Caucasian), 29 caregivers (76 % female; 72 % Caucasian), and 42 providers. Four barriers were identified that could generate miscommunication between PwCF-caregivers and providers: Tired = Fatigued/Sleepy versus Tired = Burnout, Vacation and Travel, Knowledge and Skills About CF Regimen, and Daily Habits or Routines. PwCF and caregivers used similar words as providers, but conceptualized barriers differently. PwCF and caregivers discussed barriers pragmatically, however, providers viewed certain barriers more abstractly or unidimensionally, or did not discuss them. CONCLUSIONS PwCF-caregivers and providers may not align in how they discuss barriers, which may contribute to miscommunication about adherence challenges. PRACTICE IMPLICATIONS Patient-centered communication strategies may enhance providers' understandings of PwCF-caregiver perspectives on barriers and facilitate adherence interventions.
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Affiliation(s)
- Cyd K Eaton
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA.
| | - Sara Beachy
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Katherine A McLean
- Rush University Medical Center, Department of Pediatrics, Chicago, IL, USA
| | | | - Ruth Bernstein
- University of Miami, Department of Psychology, Coral Gables, FL, 33124, USA
| | | | | | - Kristin A Riekert
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
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16
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Jones M, Moffatt F, Harvey A, Ryan JM. Interventions for improving adherence to airway clearance treatment and exercise in people with cystic fibrosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mandy Jones
- Centre for Research in Rehabilitation, School of Health Sciences and Social Care; Brunel University; Uxbridge UK
| | - Fiona Moffatt
- School of Health Sciences; University of Nottingham; Nottingham UK
| | - Alex Harvey
- School of Health Sciences and Social Care; Brunel University; Uxbridge UK
| | - Jennifer M Ryan
- Institute of Environment, Health and Societies; Brunel University London; Uxbridge UK
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17
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Dixon E, Puckey M, Collins N, Marsh G, Pabary R. Striving for perfection, accepting the reality: A reflection on adherence to airway clearance and inhalation therapy for paediatric patients with chronic suppurative lung disease. Paediatr Respir Rev 2020; 34:46-52. [PMID: 31130423 DOI: 10.1016/j.prrv.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022]
Abstract
Non-adherence to prescribed treatment is considered the foremost cause of treatment failure in chronic medical conditions. Airway clearance techniques (ACT) play a key role in the management of chronic suppurative lung disease yet, along with inhaled therapies such as nebulised antibiotics, adherence to these is often lower than to other treatments. In this review we discuss methods of monitoring adherence to these therapies and potential barriers and outline suggestions for improving adherence in the paediatric population.
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Affiliation(s)
- Emma Dixon
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Michele Puckey
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Nicola Collins
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Gemma Marsh
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Rishi Pabary
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, SW7 2AZ, United Kingdom.
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18
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Cooley L, Hudson J, Potter E, Raymond KF, George C, Georgiopoulos AM. Clinical communication preferences in cystic fibrosis and strategies to optimize care. Pediatr Pulmonol 2020; 55:948-958. [PMID: 31977168 DOI: 10.1002/ppul.24655] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The importance of optimizing communication between clinicians and individuals and families living with cystic fibrosis (CF) about daily care, adherence, and related psychosocial concerns is well documented. The purpose of this study was to gain an understanding of interpersonal communication experiences and preferences among individuals and families living with CF as they engage with the clinical team. The study also aimed to reveal opportunities for enhancing future interpersonal communication practices. METHODS Five U.S. CF care centers participated in the following activities: (a) On-site observation of clinic interactions during outpatient visits; (b) On-site 1:1 interviews with individuals living with CF, their family members, and CF clinicians; (d) Focus groups conducted in person with CF care team members; (d) Focus groups conducted virtually with adults and family members with CF. Content analysis of transcripts and constant comparative methods were used to identify emergent themes. RESULTS Four themes related to participants' needs and preferences for clinic interactions emerged during analysis: (a) eliciting psychosocial concerns, (b) addressing childhood development and transitions, (c) negotiating agendas and sharing decisions, and (d) educating to enhance CF conversations. CONCLUSION CF clinicians and individuals and families living with CF expressed the need for resources and training to engage in better conversations with each other. Participants identified areas of high priority, including working together around social, psychological, and economic challenges, preparation for transition to adulthood, and sustaining daily care. Findings point to the value of developing advanced communication skills that foster trust-building, negotiating agendas, active listening, and collaborative goal-setting.
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Affiliation(s)
- Laura Cooley
- Division of Education and Outreach, Academy of Communication in Healthcare, Lexington, Kentucky
| | - Janella Hudson
- Division of Education and Outreach, Academy of Communication in Healthcare, Lexington, Kentucky
| | - Eileen Potter
- Department of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Katherine F Raymond
- Partnerships for Sustaining Daily Care, The Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Cynthia George
- Partnerships for Sustaining Daily Care, The Cystic Fibrosis Foundation, Bethesda, Maryland
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19
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Jaques R, Shakeel A, Hoyle C. Novel therapeutic approaches for the management of cystic fibrosis. Multidiscip Respir Med 2020; 15:690. [PMID: 33282281 PMCID: PMC7706361 DOI: 10.4081/mrm.2020.690] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/06/2020] [Indexed: 12/19/2022] Open
Abstract
Cystic fibrosis (CF) is a genetic condition characterised by the build-up of thick, sticky mucus that can damage many of the body's organs. It is a life-long disease that results in a shortened life expectancy, often due to the progression of advanced lung disease. Treatment has previously targeted the downstream symptoms such as diminished mucus clearance and recurrent infection. More recently, significant advances have been made in treating the cause of the disease by targeting the faulty gene responsible. Hope for the development of potential therapies lies with ongoing research into new pharmacological agents and gene therapy. This review gives an overview of CF, and summarises the current evidence regarding the disease management and upcoming strategies aimed at treating or potentially curing this condition.
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Affiliation(s)
- Ryan Jaques
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, UK
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20
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Martin R, Arden M, Porritt J, Wildman M, Naughton F. Investigating the Temporal Relationships between Symptoms and Nebuliser Adherence in People with Cystic Fibrosis: A Series of N-of-1 Observations. Healthcare (Basel) 2020; 8:healthcare8010022. [PMID: 31972991 PMCID: PMC7151352 DOI: 10.3390/healthcare8010022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
Treatment adherence in adults with cystic fibrosis (CF) is poor. One of the reasons identified for lack of adherence to nebulised treatments is that patients may not experience any immediate relief in their symptoms or notice changes as a result of taking their treatment, thus many report that they do not perceive there to be consequences of non adherence. The aim of the study was to investigate the temporal relationships between symptoms and adherence to nebulised treatments in adults with CF using an N-of-1 observational design. Six participants were recruited for a six-week period during which time they completed a daily online respiratory symptom questionnaire. Adherence to treatment was measured throughout the duration of the study using an eTrack® nebuliser that logged date and time of treatments taken. Data generated from each participant was analysed separately. There were significant relationships between pain and adherence for three participants, tiredness and adherence for one participant and cough and adherence for one participant. For all of these findings, the symptom and adherence were experienced on the same day. Extending the monitoring period beyond six weeks may provide increased insight into the complex relationship between symptoms and adherence in CF.
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Affiliation(s)
- Rosie Martin
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
- Correspondence:
| | - Madelynne Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
| | - Jenny Porritt
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
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21
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Olivereau L, Nave V, Garcia S, Perceval M, Rabilloud M, Durieu I, Reynaud Q. Adherence to lumacaftor-ivacaftor therapy in patients with cystic fibrosis in France. J Cyst Fibros 2020; 19:402-406. [PMID: 31902692 DOI: 10.1016/j.jcf.2019.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lumacaftor-ivacaftor combination is a promising treatment for cystic fibrosis (CF) patients homozygous for the F508del-CFTR mutation. Optimal adherence is essential to achieve full health outcomes benefits. METHODS This retrospective study used pharmacy refills data to calculate proportion of days covered (PDC). Adherence was defined as a PDC ≥80%. A logistic regression analysis was conducted to examine factors associated with medication adherence. RESULTS Ninety-six patients were included in the final cohort for analysis. The mean PDC was 96% ± 14 at 6 months, and 91% ± 17 at 12 months. The proportion of adherent patients was 89% and 83% at 6 and 12 months respectively. Age and ppFEV1 were found to affect medication adherence. CONCLUSIONS Considering the medico-economic impact of CFTR modulator therapy, high adherence rates to lumacaftor-ivacaftor found in this study are encouraging.
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Affiliation(s)
- Lucie Olivereau
- Pharmacie Centrale, Hospices Civils de Lyon, F-69230 Saint Genis Laval, France
| | - Viviane Nave
- Pharmacie Centrale, Hospices Civils de Lyon, F-69230 Saint Genis Laval, France
| | - Stephan Garcia
- Pharmacie Centrale, Hospices Civils de Lyon, F-69230 Saint Genis Laval, France.
| | - Marie Perceval
- Centre de Référence de la Mucoviscidose Adultes, Service de Médecine Interne, Groupement Hospitalier Sud, Hospices Civils de Lyon, F-69495 Pierre Bénite, France
| | - Muriel Rabilloud
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100 Villeurbanne, France
| | - Isabelle Durieu
- Centre de Référence de la Mucoviscidose Adultes, Service de Médecine Interne, Groupement Hospitalier Sud, Hospices Civils de Lyon, F-69495 Pierre Bénite, France; Université de Lyon, Équipe d'Accueil Health Services and Performance Research (HESPER) 7425, F-69003 Lyon, France
| | - Quitterie Reynaud
- Centre de Référence de la Mucoviscidose Adultes, Service de Médecine Interne, Groupement Hospitalier Sud, Hospices Civils de Lyon, F-69495 Pierre Bénite, France; Université de Lyon, Équipe d'Accueil Health Services and Performance Research (HESPER) 7425, F-69003 Lyon, France
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22
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Muther EF, Butcher JL, Riekert KA. Understanding Treatment Adherence in Cystic Fibrosis: Challenges and Opportunities. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Haidari W, Glines KR, Cline A, Feldman SR. Adherence in Acne. TREATMENT ADHERENCE IN DERMATOLOGY 2020. [DOI: 10.1007/978-3-030-27809-0_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Cave L, Milnes LJ. The lived experience of adults with cystic fibrosis: what they would tell their younger selves about the gut. J Hum Nutr Diet 2019; 33:151-158. [PMID: 31763740 PMCID: PMC7079059 DOI: 10.1111/jhn.12703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Little is known about adults’ experience of living with cystic fibrosis (CF) specifically in relation to the gut. However, their unique perspectives may be meaningful to children with CF and inform the understanding and practice of dietitians. The present study aimed to explore adults’ lived experience of the CF gut and how they learnt to manage the gut as they were growing up. Methods Semi‐structured interviews were conducted with adult inpatients (n = 10). Interviews were audio‐recorded, transcribed verbatim and accounts analysed using interpretative phenomenological analysis. Results Three super‐ordinate themes were identified: taking Creon, the learning process and this much I (now) know. Participants accounts of how CF affects the gut predominantly focused on taking Creon (pancreatin, Mylan). Various strategies were employed for coping with peer responses to taking Creon at school. Several participants reached adulthood before they understood and/or accepted that taking Creon consistently needed to be normal for them. Knowledge and understanding developed over time, with ‘CF experience’ and was shaped by family, CF care teams and other children with CF. All had unmet information needs when growing up. Having key explanations earlier, to make connections between eating, taking Creon, gaining weight and growth, did or would have helped most participants. Participants urged children to be assertive, ask questions and not only be involved in managing their diet and gut, but also begin to take control of this aspect of their CF. Conclusions Supporting development of knowledge, skills and confidence to manage diet and the gut needs to be integral to care throughout childhood.
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Affiliation(s)
- L Cave
- Children's Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - L J Milnes
- School of Healthcare, University of Leeds, Leeds, UK
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25
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Rudolf I, Pieper K, Nolte H, Junge S, Dopfer C, Sauer-Heilborn A, Ringshausen FC, Tümmler B, von Jan U, Albrecht UV, Fuge J, Hansen G, Dittrich AM. Assessment of a Mobile App by Adolescents and Young Adults With Cystic Fibrosis: Pilot Evaluation. JMIR Mhealth Uhealth 2019; 7:e12442. [PMID: 31750841 PMCID: PMC6895868 DOI: 10.2196/12442] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/25/2019] [Accepted: 07/21/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) continues to be the most common life-limiting chronic pulmonary disease in adolescents and young adults. Treatment of CF demands a high treatment time investment to slow the progression of lung function decline, the most important contributor to morbidity and mortality. Adherence is challenging in CF due to the high treatment burden and the lack of immediate health consequences in case of nonadherence. Lung function decline is particularly pronounced in the transition phase between 12 and 24 years of age. The improvement of self-management and self-responsibility and independence from parents and desire for normalcy are conflicting aspects for many adolescents with CF, which influence adherence to the time-consuming pulmonary therapy. Mobile health (mHealth) care apps could help to support self-management and independence and thereby reconcile seemingly conflicting goals to improve adherence, quality of life, and ultimately CF life expectancy. OBJECTIVE This study aimed to (1) assess user behavior and satisfaction among adolescents and young adults with CF over an observation period of three months using an mHealth app; (2) identify areas of improvement for this mHealth app; and (3) compare overall and disease-specific satisfaction, lung function, and anthropometry before and after using the mHealth app. METHODS A total of 27 adolescents and young adults with CF (age range 12-24 years, mean age 16 years, SD 3 years; 14 females, 11 males) used a free mHealth app for three months of whom 25 provided questionnaire data for analysis at the end of the study. Data collection was carried out using questionnaires on usage characteristics and life satisfaction, and standardized assessment of lung function and anthropometry. RESULTS The use of the reminder function for medication declined from 70% (15/21) of the participants at week 4 to 65% (13/20) at week 8 of the observation period. At the end of the study, only 17% (4/23) of the participants wanted to continue using the app. Nevertheless, 56% (14/25) of participants saw the mobile app as a support for everyday life. Potential improvements targeting hedonistic qualities were identified to improve mHealth app adherence. Comparisons of satisfaction with different life aspects hinted at improvements or stabilization for the subitem respiration and the subitem lack of handicap by CF, suggesting that app use might stabilize certain CF-specific aspects of the weighted satisfaction with life. Lung function and anthropometry were not affected consistently. CONCLUSIONS Most of the patients did not want to continue using the app after the study period. Only a few CF-specific aspects of weighted life satisfaction were possibly stabilized by the mHealth app; clinical parameters were not affected. Adaptation of the functions to adolescent-specific needs could improve the long-term use and thus positively affect the disease course.
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Affiliation(s)
- Isa Rudolf
- Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Centre for Lung Research, Hannover Medical University, Hannover, Germany
| | - Katharina Pieper
- Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Helga Nolte
- Haus Schutzengel, Mukoviszidose eV, Hannover, Germany
| | - Sibylle Junge
- Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Christian Dopfer
- Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Centre for Lung Research, Hannover Medical University, Hannover, Germany
| | | | - Felix C Ringshausen
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Centre for Lung Research, Hannover Medical University, Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical University, Hannover, Germany
| | - Burkhard Tümmler
- Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Centre for Lung Research, Hannover Medical University, Hannover, Germany
| | - Ute von Jan
- Peter L Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Urs-Vito Albrecht
- Peter L Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Centre for Lung Research, Hannover Medical University, Hannover, Germany
| | - Gesine Hansen
- Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Centre for Lung Research, Hannover Medical University, Hannover, Germany
| | - Anna-Maria Dittrich
- Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Centre for Lung Research, Hannover Medical University, Hannover, Germany
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Eaton CK, Gutierrez-Colina AM, Quast LF, Liverman R, Lee JL, Mee LL, Reed-Knight B, Cushman G, Chiang G, Romero R, Mao C, Garro R, Blount RL. Multimethod Assessment of Medication Nonadherence and Barriers in Adolescents and Young Adults With Solid Organ Transplants. J Pediatr Psychol 2019; 43:789-799. [PMID: 29562247 DOI: 10.1093/jpepsy/jsy016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/01/2018] [Indexed: 01/12/2023] Open
Abstract
Objective To (a) examine levels of medication nonadherence in adolescent and young adult (AYA) solid organ transplant recipients based on AYA- and caregiver proxy-reported nonadherence to different medication types and the medication-level variability index (MLVI) for tacrolimus, and (b) examine associations of adherence barriers and AYA and caregiver emotional distress symptoms with reported nonadherence and the MLVI. Method The sample included 47 AYAs (M age = 16.67 years, SD = 1.74; transplant types: 25% kidney, 47% liver, 28% heart) and their caregivers (94 total participants). AYAs and caregivers reported on AYAs' adherence barriers and their own emotional functioning. Nonadherence was measured with AYA self- and caregiver proxy-report and the MLVI for tacrolimus. Results The majority of AYAs and caregivers denied nonadherence, with lower rates of nonadherence reported for antirejection medications. In contrast, 40% of AYAs' MLVI values indicated nonadherence to tacrolimus. AYAs and caregivers who verbally acknowledged nonadherence had more AYA barriers and greater caregiver emotional distress symptoms compared with those who denied nonadherence. AYAs with MLVIs indicating nonadherence had more barriers than AYAs with MLVIs indicating adherence. Conclusions Multimethod nonadherence evaluations for AYA transplant recipients should assess objective nonadherence using the MLVI, particularly in light of low reported nonadherence rates for antirejection medications. Assessments should include adherence barriers measures, given associations with the MLVI, and potentially prioritize assessing barriers over gauging nonadherence via self- or proxy-reports. Caregiver emotional distress symptoms may also be considered to provide insight into family or environmental barriers to adherence.
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Affiliation(s)
| | | | | | | | - Jennifer L Lee
- Children's Healthcare of Atlanta.,Emory University School of Medicine
| | - Laura L Mee
- Children's Healthcare of Atlanta.,Emory University School of Medicine
| | | | | | - Gloria Chiang
- Children's Healthcare of Atlanta.,Emory University School of Medicine
| | - Rene Romero
- Children's Healthcare of Atlanta.,Emory University School of Medicine
| | - Chad Mao
- Children's Healthcare of Atlanta.,Emory University School of Medicine
| | - Rouba Garro
- Children's Healthcare of Atlanta.,Emory University School of Medicine
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27
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Developing agency in the transition to self-management of cystic fibrosis in young people. J Adolesc 2019; 75:130-137. [PMID: 31387018 DOI: 10.1016/j.adolescence.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Young people living with a chronic illness must be supported by healthcare professionals and parents to manage their care as they move through adolescence and into adulthood. The concept of agency is relevant to this process as it involves reflecting on one's behaviour and its consequences, and considering alternative possibilities, before committing to a course of action. METHODS The aim of this study was to explore the role of agency in young people's transition to self-management of cystic fibrosis. Qualitative semi-structured interviews were carried out with 13 young people (7 female, 6 male) aged 13-22 years, recruited from three cystic fibrosis clinics in the Republic of Ireland. RESULTS By self-monitoring their behaviour and managing their symptoms the young people described a process by which they employed agency and as a result, gained confidence and a sense of control over their illness. Although, parents and health care professionals aided in the development of agency, the young people explained that it was occasionally threatened, particularly in their interactions with health care professionals. This led the young person to react defensively, and negatively affected their relationship with health care professionals. CONCLUSIONS For young people to feel supported empowered in the management of their illness, their developing ability to exercise agency must be respected and encouraged through collaborative decision making.
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28
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Dunbar P, Hall M, Gay JC, Hoover C, Markham JL, Bettenhausen JL, Perrin JM, Kuhlthau KA, Crossman M, Garrity B, Berry JG. Hospital Readmission of Adolescents and Young Adults With Complex Chronic Disease. JAMA Netw Open 2019; 2:e197613. [PMID: 31339547 PMCID: PMC6659144 DOI: 10.1001/jamanetworkopen.2019.7613] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Adolescents and young adults (AYA) who have complex chronic disease (CCD) are a growing population that requires hospitalization to treat severe, acute health problems. These patients may have increased risk of readmission as demands on their self-management increase and as they transfer care from pediatric to adult health care practitioners. OBJECTIVE To assess variation across CCDs in the likelihood of readmission for AYA with increasing age. DESIGN, SETTING, AND PARTICIPANTS Retrospective 1-year cross-sectional study of the 2014 Agency for Healthcare Research and Quality Nationwide Readmissions Database for all US hospitals. Participants were 215 580 hospitalized individuals aged 15 to 30 years with cystic fibrosis (n = 15 213), type 1 diabetes (n = 86 853), inflammatory bowel disease (n = 48 073), spina bifida (n = 7819), and sickle cell anemia (n = 57 622) from January 1, 2014, to December 1, 2014. EXPOSURES Increasing age at index admission. MAIN OUTCOMES AND MEASURES Unplanned 30-day hospital readmission. Readmission odds were compared by patients' ages in 2-year epochs (with age 15-16 years as the reference) using logistic regression, accounting for confounding patient characteristics and data clustering by hospital. RESULTS Of 215 580 participants, 115 982 (53.8%) were female; the median (interquartile range) age was 24 (20-27) years. Across CCDs, multimorbidity was common; the percentages of index hospitalizations with 4 or more coexisting conditions ranged from to 33.4% for inflammatory bowel disease to 74.2% for spina bifida. Thirty-day hospital readmission rates varied significantly across CCDs: 20.2% (cystic fibrosis), 19.8% (inflammatory bowel disease), 20.4% (spina bifida), 22.5% (type 1 diabetes), and 34.6% (sickle cell anemia). As age increased from 15 to 30 years, unadjusted, 30-day, unplanned hospital readmission rates increased significantly for all 5 CCD cohorts. In multivariable analysis, age trends in the adjusted odds of readmission varied across CCDs. For example, for AYA who had cystic fibrosis, the adjusted odds of readmission increased to 1.9 (95% CI, 1.5-2.3) by age 21 years and remained elevated through age 30 years. For AYA who had type 1 diabetes, the adjusted odds of readmission peaked at ages 23 to 24 years (odds ratio, 2.3; 95% CI, 2.1-2.6) and then declined through age 30 years. CONCLUSIONS AND RELEVANCE These findings suggest that hospitalized AYA who have CCDs have high rates of multimorbidity and 30-day readmission. The adjusted odds of readmission for AYA varied significantly across CCDs with increasing age. Further attention is needed to hospital discharge care, self-management, and prevention of readmission in AYA with CCD.
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Affiliation(s)
- Peter Dunbar
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matt Hall
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City School of Medicine, Kansas City
- Children’s Hospital Association, Lenexa, Kansas
| | - James C. Gay
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jessica L. Markham
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City School of Medicine, Kansas City
| | - Jessica L. Bettenhausen
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City School of Medicine, Kansas City
| | - James M. Perrin
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Karen A. Kuhlthau
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Morgan Crossman
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Brigid Garrity
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay G. Berry
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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29
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Welsner M, Sutharsan S, Taube C, Olivier M, Mellies U, Stehling F. Changes in Clinical Markers During A Short-Term Transfer Program of Adult Cystic Fibrosis Patients from Pediatric to Adult Care. Open Respir Med J 2019; 13:11-18. [PMID: 31908684 PMCID: PMC6918541 DOI: 10.2174/1874306401913010011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/15/2019] [Accepted: 06/18/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Transition from child-oriented to adult-oriented health care in Cystic Fibrosis (CF) has become more important over recent decades as the survival of people with this disease has increased. The transition process usually begins in adolescence, with full transfer completed in early adulthood. Objective: This study investigated the impact of a short-term transfer program on clinical markers in an adult CF cohort still being managed by pediatricians. Methods: Clinically relevant data from the year before (T-1), the time of Transfer (T) and the year after the transfer (T+1) were analysed retrospectively. Results: 39 patients (median age 29.0 years; 64% male) were transferred between February and December 2016. Lung function had declined significantly in the year before transfer (in % predicted: Forced Expiratory Volume in 1 second (FEV), 62.8 vs. 57.7, p <0.05; Forced Vital Capacity (FVC), 79.9 vs. 71.1, p<0.05), but remained stable in the year after transfer (in % predicted: FEV: 56.3; FVC 68.2). BMI was stable over the whole observational period. There was no relevant change in chronic lung infection with P. aeruginosa, Methicillin-Resistant Staphylococcus aureus (MRSA) and Burkholderia sp. during the observation period. The number of patient contacts increased significantly in the year after versus the year before transfer (inpatient: 1.51 vs. 2.51, p<0.05; outpatient: 2.67 vs. 3.41, p<0.05). Conclusions: Our data show that, within the framework of a structured transfer process, it is possible to transfer a large number of adult CF patients, outside a classic transition program, from a pediatric to an adult CF center in a short period of time, without any relevant changes in clinical markers and, stability.
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Affiliation(s)
- Matthias Welsner
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Margarete Olivier
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children´s Hospital, University of Duisburg-Essen, Essen, Germany
| | - Uwe Mellies
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children´s Hospital, University of Duisburg-Essen, Essen, Germany
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children´s Hospital, University of Duisburg-Essen, Essen, Germany
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Piper N, Bajic M, Selvadurai H, Robinson P, Zurynski Y, Fitzgerald DA. Question 13: Can we predict the need for lung transplantation in children with cystic fibrosis? Paediatr Respir Rev 2019; 30:30-33. [PMID: 30987796 DOI: 10.1016/j.prrv.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Nick Piper
- Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Marko Bajic
- Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Hiran Selvadurai
- Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Paul Robinson
- Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Yvonne Zurynski
- Macquarie University, Discipline of Health Systems and Sustainability, Ryde, Sydney, NSW, Australia
| | - Dominic A Fitzgerald
- Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia.
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31
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Lerch MF, Thrane SE. Adolescents with chronic illness and the transition to self-management: A systematic review. J Adolesc 2019; 72:152-161. [PMID: 30903932 DOI: 10.1016/j.adolescence.2019.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/11/2019] [Accepted: 02/24/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Chronic illness effects one in ten adolescents worldwide. Adolescence involves a desire for autonomy from parental control and the necessity to transition care from parent to child. This review investigates the transition to adolescent self-management of chronic illness treatment behaviors in the context of parent-adolescent relationships. METHODS A systematic search of PubMed, CINAHL, and Web of Science was conducted from earliest database records to early June 2017. Articles were included if they focused on adolescents, addressed illness self-management, discussed the parent-adolescent relationship, and were published in English. Articles were excluded if the chronic illness was a mental health condition, included children younger than 10 years of age, or lacked peer review. RESULTS Nine studies met inclusion criteria. Outcomes included challenges to adolescent self-management, nature of the parent-adolescent relationship, illness representation, perceptions of adolescent self-efficacy in compliance, medical decision making, laboratory measures, and adolescent self-management competence. Across diagnoses, parents who were available to monitor, be a resource, collaborate with their adolescent, and engage in ongoing dialogue were key in the successful transition to autonomous illness management. CONCLUSIONS There is a paucity of research addressing the experiences of adolescents in becoming experts in their own care.
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Affiliation(s)
- Matthew F Lerch
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Susan E Thrane
- College of Nursing, The Ohio State University, 322 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, United States.
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32
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Longacre M, Grande S, Hager A, Montan M, Bergquist RP, Martensson M, Kotzbauer G. Clinical Adoption of mHealth Technology to Support Pediatric Cystic Fibrosis Care in Sweden: Qualitative Case Study. JMIR Pediatr Parent 2018; 1:e11080. [PMID: 31518297 PMCID: PMC6715072 DOI: 10.2196/11080] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/25/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have potential to improve self-management and care co-ordination of pediatric chronic diseases requiring complex care, such as cystic fibrosis (CF). Barriers to implementation include the lack of support and infrastructure to use mHealth in the clinical microsystem. Coproducing mHealth technology with patients, clinicians, and designers may increase the likelihood of successful integration into the clinical setting. OBJECTIVE This study explored the development, adoption, and integration of a new, co-produced mHealth platform (Genia) for the management of pediatric CF in Sweden. METHODS A retrospective, qualitative case study approach was used. The case was defined as the process of introducing and using Genia at the Pediatric Cystic Fibrosis Center at Skåne University Hospital in Lund, Sweden. Data sources included interviews, presentations, meeting notes, and other archival documents created between 2014 and 2017. To be included, data sources must have described or reflected upon the Genia adoption process. Iterative content analysis of data source materials was conducted by 2 qualitatively trained researchers to derive themes characterizing the mHealth clinical adoption process. RESULTS In total, 4 core themes characterized successful clinical integration of Genia in Lund: cultural readiness to use mHealth; use of weekly huddles to foster momentum and rapid iteration; engagement in incremental "Genia Talk" to motivate patient adoption; and co-design approach toward pediatric chronic care. CONCLUSIONS Principles of quality improvement, relational co-ordination, user-centered design, and coproduction can facilitate the integration of mHealth technology into clinical care systems for pediatric CF care.
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Affiliation(s)
- Meghan Longacre
- The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Stuart Grande
- The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | | | | | | | - Maria Martensson
- Lund Pediatric Cystic Fibrosis Center, Skane University Hospital, Lund, Sweden
| | - Greg Kotzbauer
- The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
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33
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Klee P, Bussien C, Castellsague M, Combescure C, Dirlewanger M, Girardin C, Mando JL, Perrenoud L, Salomon C, Schneider F, Schwitzgebel VM. An Intervention by a Patient-Designed Do-It-Yourself Mobile Device App Reduces HbA1c in Children and Adolescents with Type 1 Diabetes: A Randomized Double-Crossover Study. Diabetes Technol Ther 2018; 20:797-805. [PMID: 30403495 DOI: 10.1089/dia.2018.0255] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Prevention of type 1 diabetes mellitus (T1DM)-related complications is dependent on metabolic control. The recommended glycated hemoglobin (HbA1c) values <7.5% (58.5 mmol/mol) are met only by a minority of diabetic children and especially adolescents. The aim of this study was to evaluate the impact of an intervention comprising the use of Webdia, a patient-designed app for smartphones, on metabolic control of T1DM in children. METHODS Fifty-five patients with T1DM, 10-18 years of age, were included in this single-center, randomized double-crossover study. We tested an intervention consisting of using Webdia for 3 months with monthly feedback and adaptation of the treatment. Main outcome was modification of HbA1c. Secondary outcomes were the prevalence of hypoglycemia and quality of life (QoL). RESULTS Of the 55 included patients, 33 completed the study, 9 dropped out, and 13 were excluded due to insufficient use of the app. The app was well accepted by the users who completed the study (46.4% rated the program as good and 39.3% as excellent). The intervention led to a reduction of HbA1c by 0.33%, compared to the control group in which HbA1c rose by 0.21% (P = 0.048) in patients with HbA1c values >8.0% (63.9 mmol/mol) at inclusion, without increasing the prevalence of hypoglycemia (8.52 ± 9.45 hypoglycemic events during last 2 weeks of intervention vs. 7.62 ± 6.37 observation, P = 0.680). QoL scores were not modified. CONCLUSIONS The intervention resulted in a significant decrease in HbA1c, without increasing the prevalence of hypoglycemia in patients with initial HbA1c >8.0% (63.9 mmol/mol).
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Affiliation(s)
- Philippe Klee
- 1 Pediatric Endocrine and Diabetes Unit, Department of Pediatrics, University Hospitals of Geneva , Geneva, Switzerland
- 2 Diabetes Center of the Faculty of Medicine, University of Geneva , Geneva, Switzerland
| | - Catherine Bussien
- 3 Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva , Geneva, Switzerland
| | | | - Christophe Combescure
- 5 Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals of Geneva , Geneva, Switzerland
| | - Mirjam Dirlewanger
- 1 Pediatric Endocrine and Diabetes Unit, Department of Pediatrics, University Hospitals of Geneva , Geneva, Switzerland
- 2 Diabetes Center of the Faculty of Medicine, University of Geneva , Geneva, Switzerland
| | - Celine Girardin
- 1 Pediatric Endocrine and Diabetes Unit, Department of Pediatrics, University Hospitals of Geneva , Geneva, Switzerland
- 2 Diabetes Center of the Faculty of Medicine, University of Geneva , Geneva, Switzerland
| | | | - Luz Perrenoud
- 4 Care Directorate, University Hospitals of Geneva , Geneva, Switzerland
| | - Carole Salomon
- 7 Pediatric Research Platform, Department of Pediatrics, University Hospitals of Geneva , Geneva, Switzerland
| | - Franck Schneider
- 8 Division of Digital Communication, University Hospitals of Geneva , Geneva, Switzerland
| | - Valerie M Schwitzgebel
- 1 Pediatric Endocrine and Diabetes Unit, Department of Pediatrics, University Hospitals of Geneva , Geneva, Switzerland
- 2 Diabetes Center of the Faculty of Medicine, University of Geneva , Geneva, Switzerland
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Everhart RS, Molitor SJ, Wentz D, Schmidt HJ, Schechter MS. Identifying and Integrating Parent Priorities for Psychosocial Support Services in a Pediatric Cystic Fibrosis Clinic. J Clin Psychol Med Settings 2018; 26:235-241. [PMID: 30368723 DOI: 10.1007/s10880-018-9588-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Engaging parents early in the development of psychosocial support programs in cystic fibrosis (CF) clinics may enable services and care team recommendations to be tailored appropriately. This pilot study identified psychosocial priorities of parents of children with CF related to treatment adherence, parent/child mental health, and CF-related communication. Forty parents of children with CF (2 months to 17 years) completed an anonymous 17-item survey during routine clinic visits that assessed priorities related to psychosocial services. Elements of a quality improvement framework were used to develop the survey and determine recommendations based on findings. Parents reported the most interest in support related to improving adherence to respiratory therapies and helping children complete treatments independently. Other priority areas included services that helped children cope with feelings of isolation or abnormality due to CF and strategies to improve communication with the care team. Additionally, the majority of families indicated that they preferred receiving psychosocial services during routine clinic visits, followed by periodic parent workshops. Based on survey results, the psychosocial team at our center developed a survey/response model (e.g., roundtables, workshops) that may serve useful for other CF care teams as they identify the priorities of parents and adapt to their needs.
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Affiliation(s)
- Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA.
| | - Stephen J Molitor
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
| | - Dena Wentz
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - H Joel Schmidt
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Michael S Schechter
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
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Gruet M. Fatigue in Chronic Respiratory Diseases: Theoretical Framework and Implications For Real-Life Performance and Rehabilitation. Front Physiol 2018; 9:1285. [PMID: 30283347 PMCID: PMC6156387 DOI: 10.3389/fphys.2018.01285] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Fatigue is a primary disabling symptom in chronic respiratory diseases (CRD) with major clinical implications. However, fatigue is not yet sufficiently explored and is still poorly understood in CRD, making this symptom underdiagnosed and undertreated in these populations. Fatigue is a dynamic phenomenon, particularly in such evolving diseases punctuated by acute events which can, alone or in combination, modulate the degree of fatigue experienced by the patients. This review supports a comprehensive inter-disciplinary approach of CRD-related fatigue and emphasizes the need to consider both its performance and perceived components. Most studies in CRD evaluated perceived fatigue as a trait characteristic using multidimensional scales, providing precious information about its prevalence and clinical impact. However, these scales are not adapted to understand the complex dynamics of fatigue in real-life settings and should be augmented with ecological assessment of fatigue. The state level of fatigue must also be considered during physical tasks as severe fatigue can emerge rapidly during exercise. CRD patients exhibit alterations in both peripheral and central nervous systems and these abnormalities can be exacerbated during exercise. Laboratory tests are necessary to provide mechanistic insights into how and why fatigue develops during exercise in CRD. A better knowledge of the neurophysiological mechanisms underlying perceived and performance fatigability and their influence on real-life performance will enable the development of new individualized countermeasures. This review aims first to shed light on the terminology of fatigue and then critically considers the contemporary models of fatigue and their relevance in the particular context of CRD. This article then briefly reports the prevalence and clinical consequences of fatigue in CRD and discusses the strengths and weaknesses of various fatigue scales. This review also provides several arguments to select the ideal test of performance fatigability in CRD and to translate the mechanistic laboratory findings into the clinical practice and real-world performance. Finally, this article discusses the dose-response relationship to training and the feasibility and validity of using the fatigue produced during exercise training sessions in CRD to optimize exercise training efficiency. Methodological concerns, examples of applications in selected diseases and avenues for future research are also provided.
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Shakkottai A, Kaciroti N, Kasmikha L, Nasr SZ. Impact of home spirometry on medication adherence among adolescents with cystic fibrosis. Pediatr Pulmonol 2018; 53:431-436. [PMID: 29457700 DOI: 10.1002/ppul.23950] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/21/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Medication adherence among adolescents with cystic fibrosis (CF) is often suboptimal and this has significant impact on their health and quality of life. The purpose of the study was to evaluate the impact of frequent home pulmonary function (PFT) monitoring on medication adherence among adolescents with CF. HYPOTHESIS We hypothesized that weekly home PFT monitoring will improve adherence while not significantly adding to the treatment burden. METHODS Individuals aged 12-21 years with CF were provided a spirometer to measure PFTs weekly for 1 year. Results were reviewed weekly via telephone. PFT data were downloaded from the device during quarterly clinic visits. Adherence was calculated from prescription refill data and compared to the previous year. Perceptions of treatment burden were assessed using the CF questionnaire-revised (CFQ-R) quality of life measure. Health outcome measures including nutritional status and PFTs from clinic were collected for the study period and the year prior. RESULTS Thirty-nine subjects participated in the study. Mean age was 15.89 ± 2.18 years and 54% were female. Mean adherence to weekly spirometry monitoring was 59.47 ± 24.60%. Values generated on the device showed good correlation with those obtained in clinic. Mean medication possession ratio (MPR) was 60% in the previous year and 65% during the study (P = 0.04). Mean treatment burden scaled score on the CFQ-R was 68 at enrollment and 66 at study completion (P = 0.14). CONCLUSIONS Frequent home PFT monitoring is feasible in CF adolescents and could successfully improve medication adherence without significantly impacting treatment burden.
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Affiliation(s)
| | - Niko Kaciroti
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lauren Kasmikha
- Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
| | - Samya Z Nasr
- Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
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Li SS, Hayes D, Tobias JD, Morgan WJ, Tumin D. Health insurance and use of recommended routine care in adults with cystic fibrosis. CLINICAL RESPIRATORY JOURNAL 2018; 12:1981-1988. [DOI: 10.1111/crj.12767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/14/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Susan S. Li
- Department of Pediatrics; Nationwide Children's Hospital; Columbus Ohio
- Department of Internal Medicine; The Ohio State University College of Medicine; Columbus Ohio
| | - Don Hayes
- Department of Pediatrics; Nationwide Children's Hospital; Columbus Ohio
- Department of Internal Medicine; The Ohio State University College of Medicine; Columbus Ohio
- Department of Surgery; The Ohio State University College of Medicine; Columbus Ohio
- Section of Pulmonary Medicine; Nationwide Children's Hospital; Columbus Ohio
| | - Joseph D. Tobias
- Department of Pediatrics; Nationwide Children's Hospital; Columbus Ohio
- Section of Pulmonary Medicine; Nationwide Children's Hospital; Columbus Ohio
- Department of Anesthesiology; The Ohio State University College of Medicine; Columbus Ohio
| | - Wayne J. Morgan
- Department of Pediatrics; University of Arizona; Tucson Arizona
| | - Dmitry Tumin
- Department of Pediatrics; Nationwide Children's Hospital; Columbus Ohio
- Department of Anesthesiology & Pain Medicine; Nationwide Children's Hospital; Columbus Ohio
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Fixter V, Butler C, Daniels J, Phillips S. A Qualitative Analysis of the Information Needs of Parents of Children with Cystic Fibrosis prior to First Admission. J Pediatr Nurs 2017; 34:e29-e33. [PMID: 28131546 DOI: 10.1016/j.pedn.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Hospitalization can be stressful for patients and their families. Pre-hospitalization information is crucial in establishing a good basis for patient satisfaction. In order to develop better preparatory material for parents, this qualitative study explored whether parents of children with cystic fibrosis, admitted to a UK Children's Hospital, felt adequately prepared for their child's admission. DESIGN AND METHODS Data were collected from twelve parents whose children had been admitted within the last two years for routine intravenous antibiotics. Semi-structured interviews were analyzed using thematic analysis. RESULTS Four themes emerged from the analysis: (1) preparing for admission, (2) the ward as a challenging environment, (3) changes in the parent-professional relationship and (4) the parental role in medical care. CONCLUSION Provision of adequate preparatory information is essential in reducing parental stress, influencing how future experiences are appraised and managed. Effective parent-professional communication and opportunities to participate in care are likely to improve parental satisfaction. PRACTICE IMPLICATIONS Preparatory information prior to hospital admission greatly assists parents in making informed decisions and working as joint advocates in their child's inpatient care.
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Affiliation(s)
- Vera Fixter
- Bristol and Avon Multiple Sclerosis Service (BrAMS), Brain Centre, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, UK.
| | - Catherine Butler
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Jo Daniels
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Samantha Phillips
- Psychological Health Service, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol BS2 8BJ, UK
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Mikesell CL, Kempainen RR, Laguna TA, Menk JS, Wey AR, Gaillard PR, Regelmann WE. Objective Measurement of Adherence to Out-Patient Airway Clearance Therapy by High-Frequency Chest Wall Compression in Cystic Fibrosis. Respir Care 2017; 62:920-927. [PMID: 28424226 DOI: 10.4187/respcare.05349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Objective measures of adherence to high-frequency chest wall compression (HFCWC), a form of airway clearance therapy for patients with cystic fibrosis, are lacking. We used a novel electronic monitoring device integrated into an HFCWC vest to measure adherence compared with self-reported adherence. We determined factors that influenced adherence and how adherence correlated with baseline pulmonary function and pulmonary exacerbations. METHODS Data were collected by direct measurement of date, time of day, and duration of HFCWC use to determine the number of daily treatments and daily duration of treatments. Chart review provided prescribed airway clearance therapy treatment and demographic and clinical information. Subject and caregiver report of the daily number of airway clearance therapy treatments was obtained by telephone interviews. Analysis used 2-sample and paired t test, analysis of variance, and linear regression. RESULTS Average adherence was 69%. Adherence was highest in children (82%, P = .02) and those receiving assistance with treatment (82%, P < .001). Subjects overestimated therapy duration from a mean ± SD of 127 ± 169% by adults to 19.2 ± 26.3% by parents or guardians of children. Average adherence decreased with increasing prescribed therapy time (P = .02). Average daily therapy time and adherence had significant positive associations with baseline FEV1 percent of predicted (P = .02 and P = .02, respectively) and negative associations with pulmonary exacerbations during the pre-study period and at baseline (P = .044 and P = .02, respectively). CONCLUSIONS Greater adherence to HFCWC measured directly by a novel recorder was associated with better baseline pulmonary function and fewer exacerbations in the pre-study and baseline period. Adherence decreased with age and prescribed therapy time and increased with therapy assistance. Self-report overestimation is large and thus not an accurate measure of adherence.
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Affiliation(s)
- Christina L Mikesell
- Children's Respiratory and Critical Care Specialists, Minneapolis, Minnesota.,Pediatric Pulmonology, University of Minnesota Cystic Fibrosis Center and Masonic Children's Hospital, Minneapolis, Minnesota
| | - Robert R Kempainen
- Pulmonary and Critical Care Medicine, Hennepin County Medical Center, and the University of Minnesota Cystic Fibrosis Center and Hospital, Minneapolis, Minnesota
| | - Theresa A Laguna
- Pediatric Pulmonology, University of Minnesota Cystic Fibrosis Center and Masonic Children's Hospital, Minneapolis, Minnesota
| | - Jeremiah S Menk
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Andrew R Wey
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Philippe R Gaillard
- Department of Mathematics and Statistics, Auburn University, Auburn, Alabama
| | - Warren E Regelmann
- Pediatric Pulmonology, University of Minnesota Cystic Fibrosis Center and Masonic Children's Hospital, Minneapolis, Minnesota.
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