Dedicated Interstitial Lung Disease Clinic Improves Care for Veterans With Idiopathic Pulmonary Fibrosis

Abstract

Idiopathic Pulmonary Fibrosis (IPF) is an Interstitial Lung Disease (ILD) with significant morbidity and mortality. Guidelines recommend frequent monitoring for disease progression, co-morbidities, and early referral to pulmonary rehabilitation and palliative care 1 . Previous studies have shown improved survival in patients with ILD cared for in dedicated ILD clinics in tertiary care centers 2 . In May 2019, a dedicated weekly ILD clinic was established at the Hunter Holmes McGuire Veterans Affairs Medical Center. We performed a retrospective chart review to assess whether the ILD clinic improved adherence to guideline-based metrics in veterans with IPF. METHODS:A list of all patients on antifibrotic therapy, reflecting most individuals with IPF at our medical center, was obtained from the pharmacy. We then performed a chart-based retrospective review comparing the frequency of guideline-recommended monitoring and discussions performed for patients seen in ILD clinic compared to the general pulmonary clinic. The ILD clinic consisted of a dedicated Pulmonologist and Respiratory Therapist. Each new patient seen in the clinic completed an extensive medical, exposure and family history. A 6-minute walk test (6MWT) and bedside spirometry was attempted every patient visit. Charts from May 1, 2019 to March 31, 2020 were reviewed, reflecting the period from when ILD clinic was initiated until usual clinic operations were halted due to the COVID-19 pandemic.RESULTS: A total of 20 IPF patients were identified; 7 were followed in the ILD clinic while the remaining 13 were seen in general pulmonary clinic. Individuals followed in the ILD clinic had closer monitoring of end points used to monitor for disease progression, such as spirometry and 6MWT, with both occurring every 6 months in 85.7% of patients. In the general pulmonary clinic, 46% had PFTs every 6 months while none had 6MWT every 6 months. Of the IPF patients seen in the ILD clinic, 100% underwent screening for sleep apnea, gastroesophageal reflux disease and hypoxia, while 46.2%, 84.6% and 76.9% respectively were screened in general pulmonary clinic. ILD clinic patients also had discussions regarding pulmonary rehab and goals of care, 100% and 42.9% of the time compared to 23% and 38.5% in those seen in general pulmonary clinic.CONCLUSIONS: ILD clinics, regardless of their association with a tertiary care center, can lead to improved monitoring of disease progression and co-morbidities in patients with IPF. Such dedicated care can also lead to more referrals to pulmonary rehab and palliative care. The key limitations to this study are the sample size and the retrospective design. In addition, we may not have captured patients with IPF who were not considered to be candidates for anti-fibrotic therapy.CLINICAL IMPLICATIONS: With minimal associated cost, dedicated ILD clinics, even those located in small healthcare systems, can improve care provided to patient's with IPF.1) Idiopathic pulmonary fibrosis: diagnosis and treatment. International Consensus Statement. A...