From devices that help consumers track a wide variety of health indicators to those that allow healthcare providers to monitor disease progression, the digital technology options in healthcare have expanded rapidly.
Cystic fibrosis (CF) care has benefitted from the trend with digital technology now available to support such aspects as accessibility to healthcare, disease self-management, treatment adherence, and home-monitoring by healthcare professionals.
Some of these technologies, however, have been more successful in improving quality of life for patients with CF and their caregivers than others, according to new research published in Thorax.1
Rebecca J. Calthorpe, BMBS, MRCPCH, from the Evidence Based Child Health Group, Division of Child Health, Obstetrics & Gynaecology, at Queens Medical Centre, Nottingham, United Kingdom, and colleagues conducted a comprehensive systematic literature review to examine the evolution of CF-specific digital technologies over the past 2 decades and to determine their effectiveness in promoting home monitoring, treatment adherence, or self-management.
“We realized that technology is becoming more prominent both in healthcare as well as amongst the general population, and so we wanted to see what was already available and the evidence for it,” said Calthorpe of the motivations behind the review in an interview with Patient Care Online.
Researchers examined 59 articles and protocols relating to 48 studies from 1999-2019 with digital technology assessed for its role in:
• Home monitoring (ie, increasing accessibility to healthcare, early detection of exacerbations)
• Monitoring/promoting treatment adherence, exercise
• Self-management of treatment
When examining studies that evaluated videoconferencing between patients and providers to improve healthcare access, there were no significant differences found in respiratory function, but patient satisfaction increased. In one study, 63% of patients favorably compared a video provider visit to an in-person review.
Data for home monitoring of exacerbations, however, has been mixed, according to study authors. While smaller non-randomized studies showed a smaller decline in FEV1 status among telehealth patients using a remote digitally enhanced spirometry device, those results were not consistent with those of the subsequent large, multicenter, randomized controlled Early Intervention in Cystic Fibrosis Exacerbation (eICE) trial.2 eICE showed that while home monitoring resulted in early detection of exacerbations vs usual care, there was no significant difference in FEV1 decline between groups. The study was terminated early for futility.
“I think probably the technologies that don’t work very well [are] the ones that lead to additional treatment burdens for patients. The eICE trial demonstrated this quite nicely,” said Calthorpe. “Although this was looking at home monitoring, they asked patients to do home spirometry twice weekly and then upload the results which would be sent to the CF team. They had poor adherence to the protocol, and I think this was likely because of the increased treatment burden associated with this.”
Next: Home monitoring
1. Calthorpe RJ, Smith S, Gathercole K, Smyth AR. Using digital technology for home monitoring, adherence and self-management in cystic fibrosis: a state-of-the-art review. Thorax. 2019;doi:10.1136/thoraxjnl-2019-213233. Accessed 21 Nov 2019.
2. Lechtzin N, Mayer-Hamblett N, West NE, et al. Home Monitoring of Patients with Cystic Fibrosis to Identify and Treat Acute Pulmonary Exacerbations. eICE Study Results. Am J Respir Crit Care Med. 2017;doi: 10.1164/rccm.201610-2172OC. Accessed 26 Nov 2019.