Heather Green is a respiratory physician treating patients with cystic fibrosis at the Manchester Adult CF Center, the second largest adult CF Center in the UK. Heather has led efforts in implementing home monitoring this year and shares some of the innovative practices developed to ensure success for both patients and the clinical team. She also offers her tips to others!
We tried several approaches but found a face-to-face start session is ideal for patient success with the new technology. With COVID-19 challenges, we initially onboarded patients in the hospital’s parking lot. This enabled us to quickly get many started with home monitoring. When we meet, we hand over the device and go through the app registration process together. We observed that some patients need help entering their correct ethnicity, which is important for predicted values. Also, when we create a profile together, we can ensure the height from our clinic measurements is used.
For those that live further away, we mail them a device and, if needed, help get them started on a video call. We have had some home onboarding conducted by our nurses as well, when home visits are required for certain tests. The Manchester Adult CF Center currently has over 300 adult patients on the platform.
We started with a small team of myself and two physiotherapists. As we became more comfortable with both the patient-facing technology and the clinical portal, we created an Advice and User Guide for the entire team. We then spent one-on-one time training physiotherapy and medical team members so they would be able to use the new system. This approach helped us to scale the program at a quick pace needed during COVID-19.
Our physiotherapy team text patients the day before their clinic appointment reminding them to do a lung function test. Patients who struggle with their technique may be watched directly via a video call.
We use the video feature in the NuvoAir clinician portal for our weekly home IV multidisciplinary virtual ward rounds. Patients taking IV antibiotics from home are asked to do spirometry tests once a week before our weekly virtual ward round. We then conduct a virtual review with the patient via the platform’s portal video. This enables a team, including a CF consultant, home IV specialist nurse, home care physiotherapist and CF pharmacist, to meet the patient and discuss their progress and any problems encountered and adjust management of the patient, if required. Patients really value these meetings as they feel the gap in support received between inpatient and outpatient IV antibiotic courses has been narrowed, which results in a better outcome from their antibiotic course.
Here are some tips I’m happy to share: