Clinical Outcome in Relation to Care in Centres Specialising in Cystic Fibrosis: Cross Sectional Study

• Published in: BMJ (Online) Vol. 316; no. 7147; pp. 1771 - 1775
• Main Authors: Mahadeva, Ravi, Webb, Kevin, Westerbeek, Roger C., Carroll, Nick R., Dodd, Mary E., Bilton, Diana, Lomas, David A.
• Format: Journal Article
• Language: English
• Published: England British Medical Association 13.06.1998; BMJ Group
• Subjects: Adult; Adult care services; Age; Age of Onset; Body Mass Index; Colonization; Continuity of Patient Care; Cross-Sectional Studies; Cystic fibrosis; Cystic Fibrosis - complications; Cystic Fibrosis - physiopathology; Cystic Fibrosis - therapy; England; Female; Forced Expiratory Volume; Health outcomes; Hospitals, Special - standards; Humans; Lung diseases; Male; Pediatrics; Pseudomonas aeruginosa; Pseudomonas Infections - complications; Pseudomonas Infections - physiopathology; Pseudomonas Infections - therapy; Treatment Outcome; X ray film; England; United Kingdom > UK
• ISSN: 0959-8138; 1756-1833; 1468-5833
• DOI: 10.1136/bmj.316.7147.1771

Objectives: To assess the effect on clinical outcome of managing paediatric and adult patients with cystic fibrosis at specialised cystic fibrosis centres. Design: Cross sectional study. Setting: Two adult cystic fibrosis centres in the United Kingdom. Subjects: Patients from an adult cystic fibrosis centre in Manchester were subdivided into those who had received continuous care from paediatric and adult cystic fibrosis centres (group A), and those who had received paediatric care in a centre not specialising in cystic fibrosis followed by adult care in a cystic fibrosis centre (group B). Group C were referrals to the new adult cystic fibrosis centre in Cambridge who had received neither paediatric nor adult centre care for their cystic fibrosis. Main outcome measures: Body mass index (weight (kg)/height (m²)), lung function (forced expiratory volume in one second (FEV₁ percentage of predicted)), the Northern chest x ray film score, and age at colonisation with Pseudomonas aeruginosa. Results: A prominent stepwise increase in body mass index was associated with increasing amounts of care at a cystic fibrosis centre; 18.3, 20.2, and 21.3 for groups C, B, and A respectively (P < 0.001). Improved nutritional status was correlated with a higher FEV₁ and better (lower) chest x ray film scores; r = 0.52 and -0.45 respectively (P < 0.001 for both). Conclusion: These findings provide the first direct evidence that management of cystic fibrosis in paediatric and adult cystic fibrosis centres results in a better clinical outcome, and strongly supports the provision of these specialist services.