Do children with cystic fibrosis receiving outreach care have poorer clinical outcomes than those treated at a specialist cystic fibrosis centre?
Heinrich C Weber, Philip F Robinson, Nicole Saxby and 3 others
PMID 27859825WHAT IT FOUND
Children with cystic fibrosis in outreach clinics did not have poorer lung function, body mass index or P. aeruginosa colonisation than children at a specialist centre.
Socio-economic status and remoteness did not significantly change lung function or BMI.
Key findings
01Median best FEV1% predicted was 88.8% in centre care, 97.8% in shared care and 90.8% in local care, with no significant difference (P=0.22).
02Combining shared and local outreach care, centre and outreach care did not differ significantly in median FEV1% (89.2% vs 94.3%), BMI (18.1 vs 17.6 kg/m2) or P. aeruginosa colonisation (43.7% vs 38.9%).
03Socio-economic status and remoteness did not significantly change lung function or BMI, except chronic P. aeruginosa was more common in the most disadvantaged group (35.6% vs 24.0%).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
This was an observational database comparison, not a randomised trial, so it cannot show that outreach care caused similar outcomes. The study was not adequately powered to detect small differences in lung function or nutritional status. The local care group had only 29 children, so results for that model are less stable. About 60% of patients in each outreach category could perform adequate lung function tests, so lung function results apply to a subset. Socio-economic status and remoteness were measured by postcode and census-based categories, which are less accurate in rural areas. The study had temporality problems associated with a cross-sectional design.
The easy way to misread this
Do not read this as proof that outreach care is equivalent to specialist centre care for every child with cystic fibrosis. The study was observational and not adequately powered to detect small differences, and the local care group had only 29 children.