Impact of Tiered Service Delivery Model on Antifibrotic Adherence and Outcomes Among Patients With Interstitial Lung Disease
Fred Fyles, Alice McKinnon, Sarah Agnew, Joanne Sutcliffe, Sarah Brooks, Jacqueline Barnett, Siobhan McGarvie, Annelise Simons, Apollo Kwok, Vernoica Yioe, Lisa G. SpencerABSTRACT
Introduction
Within England, Interstitial Lung Disease (ILD) services are in the process of adopting tiered ‘shared‐care’ service delivery to address increased demand. There are currently no data evaluating this model. We report on clinical outcomes of our Merseyside shared‐care ILD service delivery over 2 years.
Methods
We conducted a retrospective observational study of adults with ILD started on antifibrotic therapy through our regional centre from 01/01/2022 to 31/12/2023. Alongside demographics and clinical data, we reviewed mortality and antifibrotic adherence. Patients were grouped on tier status of follow‐up site: Tier 3 were Specialist ILD Network Hubs, Tier 2 were specialist centres with ILD nurse access, and Tier 1 were general respiratory centres with remote support from Tier 3 ILD nurses.
Results
A total of 275 patients were commenced on antifibrotic therapy (mean age 72.3, 69% male, 68% on nintedanib), with comparable cohorts across tiers. Twelve‐month all‐cause antifibrotic discontinuation was 40%, and was associated with increased age (HR 1.04, p = 0.001), but not with tier status of follow‐up site ( p = 0.084). Twelve‐month survival was 79%, and was not significantly different between tiers ( p = 0.3). Progressive fibrotic ILD was associated with increased mortality risk, whereas higher BMI and baseline lung function were associated with reduced mortality. Patients on pirfenidone were more likely to have intolerable side effects (HR 1.60, p = 0.029), and patients stopping antifibrotics had a significantly increased mortality risk (adjusted HR 2.18, p = 0.003).
Conclusion
This retrospective real‐world study suggests that a tiered approach to ILD service delivery—provided non‐specialist sites are given appropriate support—can be a safe and effective model.