Developing a Digitally Enabled Health and Wellbeing Multidisciplinary Review of Transplant: A Pilot Study

Purpose Lung transplant (LTx) recipients require regular monitoring to ensure graft function, medicines optimisation and minimisation of side effects. Traditionally, clinics are time-limited and focus on medical aspects. The aim was to evaluate physical and psychological wellbeing of LTx recipients, identify unmet needs and develop personalised care pathways with the use of electronic Patient Reported Outcome Measures (PROMs). Methods A formal Multidisciplinary review Of Transplant (MOT) clinic was set up at 1-year post LTx. An electronic form was developed with validated questionnaires to assess quality of life, psychological wellbeing (post-traumatic stress, anxiety, depression), physical and socioeconomical wellbeing. Patients completed the form online ahead of their MOT to aid systematic assessment, monitoring comorbidities and complications. A process for receiving the responses, automatically calculating scores, and populating clinician-friendly templates with areas of concern for review was created. Personalised care pathways were established in clinic based on this. Results To date, six LTx patients have been reviewed in MOT clinic. All patients fully completed the form. No clinicians were required to process data, resulting in no increased clinician time/cost. All patients had routine investigations, medical and medication optimisation reviews. Identified unmet needs in their care included: investigation of reflux (2/6), psychological support (1/6), counselling on skin changes (3/6), skin cancer screening (6/6), lack of exercise (1/6), social support (1/6), infection prophylaxis (3/6), cholesterol treatment (1/6); each addressed accordingly. Analysis of patient experience is underway but initial response has been positive. Conclusion This pilot study was successful in providing detailed health and wellbeing information electronically allowing clinicians to identify patient unmet needs and create personalised care plans at MOT clinic. This had clinical impact as it helped provide a comprehensive and high standard of care with no administrative burden on clinicians. Future studies could assess using this technology to more frequently monitor PROMs to manage patients with less face-to-face contact given the risks associated with the ongoing risk of Covid-19 in this extremely clinically vulnerable population.