Remote monitoring for virtual clinics and shared care in paediatric cystic fibrosis

Around half of the 13,000 people living with cystic fibrosis (CF) in the UK are under the age of 18.

Addenbrooke’s Hospital Paediatric Respiratory Service have been using remote monitoring technology to facilitate virtual CF clinics. It's also being used to allow shared care with satellite CF clinics at Ipswich and Peterborough City Hospitals.

Situation

Children with CF typically require 4 routine out-patient appointments a year. This places a significant burden on families and results in them missing work or school.

Addenbrooke’s Hospital provides an expert paediatric respiratory service. It acts as a regional tertiary centre for annual reviews whilst CF is managed at local satellite clinics.

Aspiration

Home monitoring was first applied during the COVID-19 pandemic.

It's now being used to provide a hybrid model of face-to-face and virtual care to children with CF. The aim is to:

• reduce the burden of out-patient visits on patients and families
• increase clinic capacity
• facilitate shared care
• identify potential complications earlier

Solution and impact

Addenbrooke’s Hospital worked with patientMpower to provide a solution for monitoring children with CF at home.

A Bluetooth spirometer used for measuring lung function integrates directly with the patientMpower app on a patient’s or parent’s smartphone. The spirometer is authorised for children over the age of 6.

Parents can manage or supervise their child’s care via patient and carer apps.

Remote monitoring data is shared in real time with the patient’s clinical team using a secure web-based portal.

The technology reduces the need for out-patient appointments by 50%. This eases the burden of care on patients and families and decreases the risk of hospital-acquired infections.

This approach allows Addenbrooke’s to maintain the same level of clinical contact as pre-COVID levels and speeds up post-COVID service recovery.

Patient remote monitoring data is available across tertiary and satellite sites to facilitate shared care.

Home monitoring helps to identify complications for early intervention. It offers reassurance and patients with lung health concerns can also avoid trips to the clinic.

Functionality

The solution consists of portable medical devices to be used by a patient at home. These link directly to an app on a smartphone which records the results and transfers the data to the hospital in real time.

Capabilities

This solution enables patients to have their lung health monitored from home by their specialist team.

The technology also integrates with a suite of other digital devices that are used at home to assess:

• oxygen saturation
• blood pressure
• temperature
• body weight
• heart rate

This allows remote care by holistic, multi-disciplinary teams if needed.

Healthcare professionals can see all recorded health data in real time, allowing synchronous flow of information during virtual appointments. Specialist indicators, such as flow volume curves, allow healthcare professionals to assess the quality of the data.

Alerts notify patients and healthcare professionals of results which are outside of threshold ranges. This means complications can be identified early.

The app also provides a number of features to empower self-care including:

• medication reminders
• activity tracking
• symptom diaries
• health-related quality of life assessments

Scope

Home spirometers were given to all CF patients between the ages of 6 and 16 who were under the care of Addenbrooke’s Hospital and its shared care clinics. This excluded those with a sweat-positive indeterminate diagnosis.

The technology was also used to remotely monitor:

• children with complex asthma
• children with respiratory related neuromuscular disease complications
• adults with chronic and acute clinical conditions

Dedicated solutions are also available for monitoring:

• chronic respiratory diseases like chronic obstructive pulmonary disorder
• interstitial lung disease
• lung and kidney transplantation
• heart failure
• COVID-19

Key quotes

“Remote monitoring has given us, as clinicians, the confidence to integrate virtual clinics into our normal care protocols. Without the patientMpower solution we would not have access to the data we need to provide high quality care remotely.

Now, patients have alternate virtual and face-to-face reviews, reducing out-patient appointments by 50%. Patients love not having to attend clinics, and despite COVID-19 we are maintaining our service capacity at 2019 levels.

Having access to home data also means the clinical staff have quickly identified complications before they progress, and have been able to admit patients for intravenous antibiotics earlier than previously possible.”

Laura Lowndes, Clinical Specialist Paediatric Respiratory Physiotherapist at Addenbrooke’s Hospital.

Key contact

Laura Lowndes, Clinical Specialist Paediatric Respiratory Physiotherapist, Addenbrooke’s Hospital

l.lowndes@nhs.net