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Annual review or continuous assessment?

Cystic fibrosis (CF) is a serious life-long and ultimately lifethreatening disease. Great strides have been made in the last few years in terms of understanding the basic pathophysiology, in consolidating present treatments and developing new ones. As a result of this, life expectancy and the quality oflife for CF patients has improved dramatically1. One of the main reasons why treatment has improved so much is the development of specialized CF centres that are able to support a multiprofessional team with considerable experience and expertise in the field. This specialized team can closely monitor the progress of each patient in the clinic so that any change in disease severity can be detected at an early stage and appropriate measures taken-either to minimize or hopefully reverse any adverse effects. Most large CF clinics have regular weekly meetings to review each patient seen and to discuss any management changes that may need to be made. This forum allows the various health professionals to share their findings and to make specific treatment plans. Many CF units use a stylized proforma sheet for recording clinic visits. (Available on request from RD.) This allows all aspects of the patient's physical condition and routine care to be carefully documented. Additionally, at least annually, there is a need for surveillance of other parameters, for example chest X-ray, full lung function, blood count, blood glucose and liver function tests. This allows the CF team to form an overview of each patient's general progress and can best be done at the time of measurements. In an ideal world this should happen within the above system and thus the concept of 'continuous assessment' should act as a cost effective and efficient way of long-term patient monitoring. However, 'the best laid plans o' mice an' men Gang aft a-gley' (Burns 1785). This has led, therefore, to the development of a more formalized 'annual review' process which involves a much more structured and detailed investigation of the patient, often including a day case admission to the ward once a year. This system also lends itself well to the patients who have shared care with their local hospitals and attend the CF centre 4 monthly, 6 monthly or yearly. Increasingly in present day practice, formalized CF databases are being developed in order to facilitate clinical audit and continued research and development. It is anticipated that these will highlight continuing overall problems for the patients as a group and ultimately lead to better treatment for all. The process ofannual review in a large clinic such as that at Great Ormond Street Hospital for children with 270 patientsis likely to be expensive and time consuming, not only for the staff concerned but also for the patients and their families. Is it cost effective, is it improving quality of patient care, or is the previous system of continuous assessment in fact perfectly adequate if applied properly? It is with these questions in mind that a careful analysis of the initial experience of a formalized annual review system was undertaken. The current review system has evolved over the past 20 months to involve middle grade medical staff, nursing staff, dietitian, physiotherapist and psychologist and a follow-up appointment at consultant level. A breakdown of the areas covered at review is given in Table 1. The results of an audit of 100 cases will be used as a framework to discuss these areas, the mean age of this group was 9.8 years (range 1. 1 to 16.5) and included 51 males and 49 females.