title: A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis.
abstract: BACKGROUND
  At our hospital the current model of care for children with moderate-severe CF is focused on intensive inpatient intervention, regular outpatient clinic review and specialist outreach care as required. An alternative model providing more regular physiotherapy and dietetic outreach support, in addition to these specialist services, may be more effective.
  
  
  METHODS
  16 children (4 male; 12 female; mean age 10.9±2.93; range 4-15 years) who required >40days of IV antibiotics in the 12-months pre-intervention were enrolled. Physiotherapy included weekly-supervised exercise sessions, alongside regular review of home physiotherapy regimens. Dietetic management included 1-2 monthly monitoring of growth, appetite, intake and absorption, and nutrition education sessions.
  
  
  RESULTS
  There was a 23% reduction in inpatient IV antibiotic requirement and 20% reduction in home IV antibiotic requirement during the intervention year. Cost-benefit analyses showed savings of £113,570. VO(2Peak) increased by 4.9 ml·kg·min(-1) (95%CI 1.01 to 8.71; p=0.02), and 10 m-MSWT distance and increment achieved increased by 229 m (95%CI 109 to 350; p<0.001) and 2 levels (95%CI 1 to 3; p<0.002) respectively. No significant differences in physiological and patient reported outcomes were demonstrated, although there was a possible trend towards improvement in outcomes when compared to the pre-intervention year.
  
  
  CONCLUSIONS
  This pilot programme demonstrated a reduction in IV and admission requirements with a cost benefit in a small group of children with moderate-severe CF. A fully powered clinical trial is now warranted.
authors: Cystic Fibrosis Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Portex Respiratory Unit, University College London Institute of Child Health, London, United Kingdom. Electronic address: sean.ledger@gosh.nhs.uk.
authors: Sean J
authors: SJ
authors: Ledger
authors: Elizabeth
authors: E
authors: Owen
authors: S Ammani
authors: SA
authors: Prasad
authors: Allan
authors: A
authors: Goldman
authors: Jane
authors: J
authors: Willams
authors: Paul
authors: P
authors: Aurora
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003550:Cystic Fibrosis / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D058996:Quality Improvement
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cystic fibrosis; Dietetics; Exercise; Physiotherapy