Automatic referrals within a cystic fibrosis multidisciplinary clinic improve patient evaluation and management

Amy Darukhanavala; Ted Kremer

doi:10.1016/j.jcte.2021.100259

Automatic referrals within a cystic fibrosis multidisciplinary clinic improve patient evaluation and management

J Clin Transl Endocrinol. 2021 Jun 12:24:100259. doi: 10.1016/j.jcte.2021.100259. eCollection 2021 Mar.

Authors

Amy Darukhanavala¹, Ted Kremer²

Affiliations

¹ Department of Pediatric Endocrinology, University of Massachusetts Medical Center, Worcester, MA, USA.
² Department of Pediatric Pulmonology, University of Massachusetts Medical Center, Worcester, MA, USA.

Abstract

AUTOMATIC REFERRALS WITHIN A CYSTIC FIBROSIS MULTIDISCIPLINARY CLINIC IMPROVE PATIENT EVALUATION AND MANAGEMENT.

Background: Cystic fibrosis (CF) affects multiple systems beyond the pulmonary system, including the gastrointestinal and endocrine systems. Many CF clinics focus on pulmonary effects, initiating referrals to other specialties only when a condition has been identified by the primary pulmonary team. Unfortunately, many extrapulmonary manifestations of cystic fibrosis may be overlooked. Thus, implementing a multidisciplinary clinic with automatic referrals to designated subspecialists may improve patient care.

Methods: This retrospective review of medical records examined the effects of integrating a pediatric endocrinologist into the University of Massachusetts Memorial Medical Center Pediatric CF Clinic in March 2017. In this new CF/Endocrinology clinic, all patients scheduled to see a pulmonologist were automatically referred to pediatric endocrinology. We compared rates of referrals to pediatric endocrinology, oral glucose tolerance tests (OGTTs), and bone density (DEXA) scans before (2013-2016) and after (2017-2020) implementation of this clinic. We also recorded endocrine disorders being evaluated and/or treated after implementation.

Results: The rate of referral to pediatric endocrinology increased from before (4%) to after (82%) (p < 0.0001) implementation of the CF/Endocrinology Clinic. OGTT and DEXA scan screening rates also increased from 7% to 65% (p < 0.0001) and from 6% to 63% (p = 0.0011), respectively. Before implementation, patients were evaluated by endocrinology primarily for CF-related diabetes. After implementation, the diversity of endocrine conditions under evaluation and/or management increased substantially; the most common were vitamin D insufficiency/deficiency (37.2% of clinic patients), glycemic dysregulation (36.8%), and poor weight gain/failure to thrive (17.5%).

Conclusion: Implementing a multidisciplinary CF clinic with automatic referrals to pediatric endocrinology improves patient care by promoting early detection and management of endocrine concerns that may have been overlooked and by increasing OGTT and DEXA screening rates.

Keywords: Cystic fibrosis; Endocrinology; Multidisciplinary clinic; Referral.