Telephone monitoring and home visits significantly improved the quality of life, treatment adherence and lung function in children with cystic fibrosis

Cystic Fibrosis (CF) is a chronic and systemic disease with a progressive course. As survival rates continue to improve, there is a growing demand for new therapeutic options that improve treatment adherence, disease management and quality of life (QoL) (1). The aim of this study was to evaluate the safety and effectiveness of a home care programme for children with CF and to assess the value of regular telephone contact with the CF team based at Hippokration Hospital, Thessaloniki, Greece. We recruited 60 children with a mean (SD) age of 13.25 (2.62) over a 2-year period. The home care team was coordinated by the CF centre and consisted of two nurses and two physiotherapists. The study population was divided into two groups: Group A consisted of 26 patients living within 60 km of the hospital, in Thessaloniki and its outskirts, and Group B consisted of 34 patients living 60–400 km from the hospital. Group A was offered home visits by a nurse while they were receiving intravenous antibiotic treatment and weekly visits from a physiotherapist during the study period. Group B was offered telephone communication with the home care team twice a week and whenever they needed it. The telephone calls included questions on exacerbations, respiratory infections or symptoms, weight gain, medication and treatment adherence. We evaluated the effectiveness of the home care programme by assessing the forced expiratory volume in the first second (FEV1), the days and cost of hospitalisation and QoL. All the QoL parameters and the total QoL score improved significantly after the programme started, with a mean (SD) baseline QOL score of 39.88 (8.48) and mean (SD) delta QOL score of 43.44 (14.50) (p < 0.001). FEV1% predicted showed a significant improvement from a mean baseline (SD) of 74.74 (31.50) to a mean delta (SD) of 8.00 (5.2) (p = 0.001). The days of hospitalisation decreased significantly, from a mean (SD) baseline of 5.40 (6.06) days to a mean delta (SD) of 1.65 (2.14) (p = 0.02) and the costs also decreased significantly from a mean baseline (SD) of €2053 (1429) to a mean delta (SD) of 431.00 (565.4) (p = 0.005). The two study groups had comparable baseline FEV1. No significant differences were found between the two groups in FEV1 and the days and cost of hospitalisation after the implementation of the home care programme (Table 1). Our study showed that home care was a highly effective option that improved QoL, treatment adherence and lung function among patients with CF. As a result of our findings, we recommend the use of regular telephone communication to increase treatment adherence, especially among patients with CF living in a long distance from the CF centre. New methods of care and communication between healthcare professionals and patients have been developing in the last few years. Regularly collecting medical information using telephone calls allows clinical support teams to comprehensively monitor patients with chronic conditions and adjust their treatment. It also enables them to identify if their health starts to deteriorate, which often leads to emergency department attendances and, or, hospital admissions if they are not detected quickly enough (2,3). Based on the results of this study, both the home care programme and telephone communication initiative seemed to provide promising therapeutic approaches that significantly improved the QoL, treatment adherence and lung function of children with CF.