Telemedicine for Cystic Fibrosis Patients
Telehealth is making it possible for those with rare diseases to receive expert care more efficiently. Bryan Garcia, MD, explains that although many specialties simply had to use telehealth during the pandemic, the benefits are here to stay for many of his cystic fibrosis (CF) patients. Thanks to recent Cystic Fibrosis Foundation investments in home-monitoring spirometers and newly approved medicines that allow CF patients to maintain more routine lifestyles, telehealth is not only possible, but is often preferred. Dr. Garcia explains how CF treatment lends itself to the early adoption of telehealth, but he also emphasizes that the general trend towards it is inevitable across the industry—noting that some clinical trials are already enabling greater participation by requiring fewer in-person visits.
Featuring:
Learn more about Bryan Garcia, MD
Release Date: May 4, 2022
Expiration Date: May 3, 2025
Disclosure Information:
Planners:
Ronan O’Beirne, EdD, MBA
Director, UAB Continuing Medical Education
Katelyn Hiden
Physician Marketing Manager, UAB Health System
The planners have no relevant financial relationships with ineligible companies to disclose.
Faculty:
Bryan Garcia, MD
Assistant Professor, Critical Care Medicine & Pulmonology
Dr. Garcia has no relevant financial relationships with ineligible companies to disclose.
There is no commercial support for this activity.
Bryan Garcia, MD
Specialties include Critical Care Medicine and Pulmonology.Learn more about Bryan Garcia, MD
Release Date: May 4, 2022
Expiration Date: May 3, 2025
Disclosure Information:
Planners:
Ronan O’Beirne, EdD, MBA
Director, UAB Continuing Medical Education
Katelyn Hiden
Physician Marketing Manager, UAB Health System
The planners have no relevant financial relationships with ineligible companies to disclose.
Faculty:
Bryan Garcia, MD
Assistant Professor, Critical Care Medicine & Pulmonology
Dr. Garcia has no relevant financial relationships with ineligible companies to disclose.
There is no commercial support for this activity.
Transcription:
Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward. Here's Melanie Cole.
Melanie Cole, MS (Host): Welcome to UAB MedCast. I'm Melanie Cole, and I invite you to join us as we discuss cystic fibrosis and the future of telemedicine. Joining me today is Dr. Bryan Garcia. He's a pulmonologist in critical care medicine and an assistant professor at UAB.
Dr. Garcia, it's a pleasure to have you join us. I love this topic and telemedicine has certainly come to the forefront for patients and providers in recent times. It's happening all over the country. How have you been using telemedicine for your patients?
Dr. Bryan Garcia: Oh, that's a great question. Yeah, I totally agree. It's really amazing how the last two years have changed our ability to connect with our patients in different ways, obviously. And it's in large part due to the early constraints of the pandemic that we have made these changes so quickly. And I think that our CF group and, in general, the CF Foundation early on in the pandemic made really rapid, tremendous strides towards making sure that we could continue to maintain a close relationship with the patients without having to initially expose them to COVID. And now, that has even really morphed into how do we continue to provide care for them that's really more convenient and accessible and affordable?
So our group right now sees about half of our patients through a telemedicine platform. And that could be through a simple telephone call, but we really try to actually have them all be some form of video visit. I think it helps to maintain that relationship as close as possible despite the distance. And that continues right now. We see at least half of our patients through televisits, which is fantastic for people with rare diseases to be able to access specialty care that's really at the tip of their fingers, as opposed to having to drive several hundred miles to come see us, which is expensive at five bucks a gallon right now and very not conducive to them continuing to maintain normal life when they have to take a day or even two days off from work or from family life in order to come to their doctor's visits. So for all these reasons, I think telemedicine is providing a tremendous opportunity to provide access to care for our CF patients.
Melanie Cole, MS (Host): Dr. Garcia, we certainly have seen this pandemic encouraging healthcare systems to be more creative and innovative in their ability to deliver care. Can you tell us a little how this has transformed your decision-making scenario and how have patients adapted to it?
Dr. Bryan Garcia: All great questions. The first one is how does telemedicine affect our decision-making? And so you can imagine early on, there was not too much thought that went into this. It was really just, "Let's connect with the patients from afar." But fortunately, the CF Foundation invested very heavily in getting home monitoring systems for these patients, which included basically a spirometer as well as the ability to access samples of their sputum, which is actually very important for us for decision-making when patients aren't doing well to know what microbes might be growing in their airways and also what's their most recent lung function. We found these spirometers to be extremely accurate compared to those we have in clinic. And so we've really taken advantage of those since that time.
Our patients in this clinic tend to be younger. They tend to be in their 20s, 30s and 40s. And that's due in large part to the kind of demographics of cystic fibrosis right now. We'll see that continue to move older and older. But right now, that's where the bulk of our patients exist. And those folks, as you can imagine, are far more technologically savvy. Most have actually, you know, video phones, cell phones that are smartphones, and they can do this from sometimes their cars, not that they're driving of course, but they might you know, during the work day, go out to their car and basically have a visit in their car, you know, in private while they're at work on lunch break, for example, something like that. And so our patients, I think, have been able to take to the technology quickly for that reason.
The improvements in their health that they experienced around the same time as a result of some new drugs that came out coincided with them being able to have more normal lives also. And to not have to travel so far, like I said before, to be able to take a visit from your lunch break instead of having to drive 240 miles from the Pensacola area, that really benefits these people from that standpoint as well, maintaining some degree of normalcy while still being able to connect with your doctor.
Melanie Cole, MS (Host): Dr. Garcia, how has it shown efficiency while changing the care paradigm to the home, decreasing hospitalizations, obviously during COVID and readmissions? What about cost effectiveness or insurance implications? Is this cost effective? You just said it was satisfying for the patients and for the providers. But where does cost figure in?
Dr. Bryan Garcia: That's a great question. There's costs at different levels. And so it's really, where do you want to look for the cost? Like I said before, for the patient, this is very cost-effective, right? For patients who live in the panhandle, they don't have to drive. They don't have to pay for gas. They don't have to pay for meals. They don't have to pay for their hotels.
For the providers, if done correctly, it should also be quite cost-effective. You should be able to significantly cut down on your overhead, for example. And then, you know, from the standpoint of healthcare utilization, if we have the ability to intervene more readily with more information, for example, if the patient doesn't need to delay their appointment for two weeks because of access to a vehicle, then we can get them their medicines earlier, and then that might also cut down on, you know, healthcare utilization, and potentially even hospital admissions and things like that. So there's, win-win win right there for potential for all parties. when telemedicine is utilized appropriately.
Melanie Cole, MS (Host): What about for other things like provider collaboration and opportunities for growth, new research being shared? Are you using it for those as well?
Dr. Bryan Garcia: When we have televisits for the CF patients, these can be or tend to be multidisciplinary where more than just a physician or a nurse practitioner sees the patients. And so we've had to adapt to being able to provide telemedicine with a multidisciplinary approach, which is different than that of a standard primary care doc, for example, who might be having a televisit with their patient where they're the only person who needs to meet with that patient that day. So there's unique challenges there for our group.
We have utilized it for remote monitoring during specific clinical trials and that is moving more mainstream. For active clinical trials at the time of the pandemic onset, many of them made exceptions for these types of visits or certain visits to be maintained as televisits. And since that time, new trials that you see coming forward are more commonly incorporating televisits for remote monitoring, as opposed to bringing the patient all the way back to the hospital, which for rare diseases, again, that's another major victory to say, "Hey, you have this unusual disease. You want to participate in a research trial, but you live in Mobile and this is being done in Birmingham." But fortunately, now let's say for example, instead of eight visits to Birmingham, now it might be three or four for some of these clinical trials. So yeah, telemedicine is extending beyond just the clinical care as well.
Melanie Cole, MS (Host): Well, it certainly is. As we wrap up, what would you like to tell other providers, some key learnings that you think that they would like to know about if they're setting up their practices for telehealth going forward? I mean, is this something that you see that you're not going to stop, because it's working and it's added benefits? And so what would you like other providers to know about that?
Dr. Bryan Garcia: There's been a lot of talk back and forth since, you know, just a few months into the pandemic about how will this continue to be reimbursed, and will it be continued to be reimbursed, for example, which is ultimately at the end of the day all physicians are still businesses. They still need to make money. They do need to be reimbursed. And I am certain that there is such bipartisan, pan-American support for telemedicine, that this is not going away and to plan for the future of how to best incorporate it into your practice, you know, pattern and practice paradigm that exists for you because each doctor is different, but you have to take advantage of this and it's not going away. And so begin to invest in it for the long-term and not just to think that once COVID is over, it's over and that there won't be telemedicine.
Melanie Cole, MS (Host): That's great advice. Invest in it for the long-term, because it's not going anywhere. And thank you so much, Dr. Garcia, for joining us today. A physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST, or you can always visit our website at uabmedicine.org/physician. That concludes this episode of UAB MedCast. And for updates on the latest medical advancements, breakthroughs and research, follow us on your social channels. I'm Melanie Cole.
Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward. Here's Melanie Cole.
Melanie Cole, MS (Host): Welcome to UAB MedCast. I'm Melanie Cole, and I invite you to join us as we discuss cystic fibrosis and the future of telemedicine. Joining me today is Dr. Bryan Garcia. He's a pulmonologist in critical care medicine and an assistant professor at UAB.
Dr. Garcia, it's a pleasure to have you join us. I love this topic and telemedicine has certainly come to the forefront for patients and providers in recent times. It's happening all over the country. How have you been using telemedicine for your patients?
Dr. Bryan Garcia: Oh, that's a great question. Yeah, I totally agree. It's really amazing how the last two years have changed our ability to connect with our patients in different ways, obviously. And it's in large part due to the early constraints of the pandemic that we have made these changes so quickly. And I think that our CF group and, in general, the CF Foundation early on in the pandemic made really rapid, tremendous strides towards making sure that we could continue to maintain a close relationship with the patients without having to initially expose them to COVID. And now, that has even really morphed into how do we continue to provide care for them that's really more convenient and accessible and affordable?
So our group right now sees about half of our patients through a telemedicine platform. And that could be through a simple telephone call, but we really try to actually have them all be some form of video visit. I think it helps to maintain that relationship as close as possible despite the distance. And that continues right now. We see at least half of our patients through televisits, which is fantastic for people with rare diseases to be able to access specialty care that's really at the tip of their fingers, as opposed to having to drive several hundred miles to come see us, which is expensive at five bucks a gallon right now and very not conducive to them continuing to maintain normal life when they have to take a day or even two days off from work or from family life in order to come to their doctor's visits. So for all these reasons, I think telemedicine is providing a tremendous opportunity to provide access to care for our CF patients.
Melanie Cole, MS (Host): Dr. Garcia, we certainly have seen this pandemic encouraging healthcare systems to be more creative and innovative in their ability to deliver care. Can you tell us a little how this has transformed your decision-making scenario and how have patients adapted to it?
Dr. Bryan Garcia: All great questions. The first one is how does telemedicine affect our decision-making? And so you can imagine early on, there was not too much thought that went into this. It was really just, "Let's connect with the patients from afar." But fortunately, the CF Foundation invested very heavily in getting home monitoring systems for these patients, which included basically a spirometer as well as the ability to access samples of their sputum, which is actually very important for us for decision-making when patients aren't doing well to know what microbes might be growing in their airways and also what's their most recent lung function. We found these spirometers to be extremely accurate compared to those we have in clinic. And so we've really taken advantage of those since that time.
Our patients in this clinic tend to be younger. They tend to be in their 20s, 30s and 40s. And that's due in large part to the kind of demographics of cystic fibrosis right now. We'll see that continue to move older and older. But right now, that's where the bulk of our patients exist. And those folks, as you can imagine, are far more technologically savvy. Most have actually, you know, video phones, cell phones that are smartphones, and they can do this from sometimes their cars, not that they're driving of course, but they might you know, during the work day, go out to their car and basically have a visit in their car, you know, in private while they're at work on lunch break, for example, something like that. And so our patients, I think, have been able to take to the technology quickly for that reason.
The improvements in their health that they experienced around the same time as a result of some new drugs that came out coincided with them being able to have more normal lives also. And to not have to travel so far, like I said before, to be able to take a visit from your lunch break instead of having to drive 240 miles from the Pensacola area, that really benefits these people from that standpoint as well, maintaining some degree of normalcy while still being able to connect with your doctor.
Melanie Cole, MS (Host): Dr. Garcia, how has it shown efficiency while changing the care paradigm to the home, decreasing hospitalizations, obviously during COVID and readmissions? What about cost effectiveness or insurance implications? Is this cost effective? You just said it was satisfying for the patients and for the providers. But where does cost figure in?
Dr. Bryan Garcia: That's a great question. There's costs at different levels. And so it's really, where do you want to look for the cost? Like I said before, for the patient, this is very cost-effective, right? For patients who live in the panhandle, they don't have to drive. They don't have to pay for gas. They don't have to pay for meals. They don't have to pay for their hotels.
For the providers, if done correctly, it should also be quite cost-effective. You should be able to significantly cut down on your overhead, for example. And then, you know, from the standpoint of healthcare utilization, if we have the ability to intervene more readily with more information, for example, if the patient doesn't need to delay their appointment for two weeks because of access to a vehicle, then we can get them their medicines earlier, and then that might also cut down on, you know, healthcare utilization, and potentially even hospital admissions and things like that. So there's, win-win win right there for potential for all parties. when telemedicine is utilized appropriately.
Melanie Cole, MS (Host): What about for other things like provider collaboration and opportunities for growth, new research being shared? Are you using it for those as well?
Dr. Bryan Garcia: When we have televisits for the CF patients, these can be or tend to be multidisciplinary where more than just a physician or a nurse practitioner sees the patients. And so we've had to adapt to being able to provide telemedicine with a multidisciplinary approach, which is different than that of a standard primary care doc, for example, who might be having a televisit with their patient where they're the only person who needs to meet with that patient that day. So there's unique challenges there for our group.
We have utilized it for remote monitoring during specific clinical trials and that is moving more mainstream. For active clinical trials at the time of the pandemic onset, many of them made exceptions for these types of visits or certain visits to be maintained as televisits. And since that time, new trials that you see coming forward are more commonly incorporating televisits for remote monitoring, as opposed to bringing the patient all the way back to the hospital, which for rare diseases, again, that's another major victory to say, "Hey, you have this unusual disease. You want to participate in a research trial, but you live in Mobile and this is being done in Birmingham." But fortunately, now let's say for example, instead of eight visits to Birmingham, now it might be three or four for some of these clinical trials. So yeah, telemedicine is extending beyond just the clinical care as well.
Melanie Cole, MS (Host): Well, it certainly is. As we wrap up, what would you like to tell other providers, some key learnings that you think that they would like to know about if they're setting up their practices for telehealth going forward? I mean, is this something that you see that you're not going to stop, because it's working and it's added benefits? And so what would you like other providers to know about that?
Dr. Bryan Garcia: There's been a lot of talk back and forth since, you know, just a few months into the pandemic about how will this continue to be reimbursed, and will it be continued to be reimbursed, for example, which is ultimately at the end of the day all physicians are still businesses. They still need to make money. They do need to be reimbursed. And I am certain that there is such bipartisan, pan-American support for telemedicine, that this is not going away and to plan for the future of how to best incorporate it into your practice, you know, pattern and practice paradigm that exists for you because each doctor is different, but you have to take advantage of this and it's not going away. And so begin to invest in it for the long-term and not just to think that once COVID is over, it's over and that there won't be telemedicine.
Melanie Cole, MS (Host): That's great advice. Invest in it for the long-term, because it's not going anywhere. And thank you so much, Dr. Garcia, for joining us today. A physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST, or you can always visit our website at uabmedicine.org/physician. That concludes this episode of UAB MedCast. And for updates on the latest medical advancements, breakthroughs and research, follow us on your social channels. I'm Melanie Cole.