The use of telehealth system in improving adherence to nebulised treatment in children with cystic fibrosis: Benefits and pitfalls

Abstract

Background : Adherence to treatment among Cystic Fibrosis (CF) patients is variable. Strategies to improve adherence via feedback to patients in home setting are being developed. Aim : To determine whether telehealth system (I-neb Insight Online), ± prompts/feedback from physiotherapists, improves adherence to nebulised treatment Method :Consenting CF patients (aged 6 -17 years) were set up to use Insight Online for self-monitoring adherence from home. Patients' baseline adherence data was recorded. Patients were asked to upload data from their I-neb 2-weekly. Over a 2-month(m) period, if uploads were not done, patients/parents were prompted by physiotherapists at regular intervals, who reviewed uploaded data and fedback to patients. Results : 28 CF patients recruited are divided into 3 groups, those who (1) independently uploaded(n=3); (2) uploaded with prompts(n=10); (3) failed to upload despite prompts(n=15). With baseline adherence ≥85%(median100%), Group 1 maintained their adherence over 2m period. The median [IQR] baseline adherence of Group 2 and Group 3 were 38% [18-51%] and 71% [54-72.5%] respectively(p=0.03). Over a 2m period, Group 2 increased their adherence by median [IQR] of 111% [33-181%] while Group 3 showed median [IQR] change 7%[-3-16%] on I-neb downloads (p=0.025). Conclusion : Using Insight Online is effective in improving adherence in patients, who engaged with regular uploads. Feedback from physiotherapists may also have a role in improving adherence. Ho…