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MDMs are a challenge for delivering IPF care: study


Care for Australians with idiopathic pulmonary fibrosis (IPF) is generally delivered in line with best practice guidance, but patients and clinicians face numerous practical barriers with multidisciplinary meeting (MDM) teams, a study shows.

A survey of IPF services at 39 public hospitals found that almost all of them provided care via MDMs that aligned with suggestions made in position statements published by the Thoracic Society of Australia and New Zealand (TSANZ) and Lung Foundation Australia (LFA).

However while 90% of MDM teams included expert respiratory physicians and radiologists;, about 60% did not include a rheumatologist or  interstitial lung disease nurse  and about a quarter did not have a histopathologist.

The study, led by researchers from Monash University, Melbourne, also showed that more than 90% of institutions had access to oxygen therapy, pulmonary rehabilitation and advanced care planning. However only about half (53%) had access to psychological support and 58% had access to clinical trials, and around 60% of hospitals had a dedicated ILD clinic.

Interviews with fifteen respiratory physicians produced feedback that all supported this model of care and their approaches to diagnosis, treatment and access to referral services for people with IPF were generally consistent with best practice guidance.

But many clinicians reported practical barriers to accessing MDM teams, particularly for those in regional hospitals. Issues often centred around the infrequency of meetings and lack of ILD specialised staff.

“I think escalating and improving things to a weekly or fortnightly meeting… the biggest issue would actually be staff availability,” said one respondent.

“We’re all pretty good at respiratory radiology, at least HRCT interpreters ourselves but we don’t have a specialized radiologist at that meeting,” said another.

Many of the respondents in regional areas said telehealth had the potential to improve the quality of MDM teams by increasing access to specialist staff, but there were ongoing technical and infrastructure barriers such as access to imaging scans.

“The gold-standard would be a video set up of local practitioners in one room and tertiary centre at the other end. Those services are very well established in the cancer setting both locally and with other centres. But they tend to get a hell of a lot more funding than respiratory services do,” said one respiratory physician.

Others described barriers to referrals to IPF care across public and private systems and with red tape.

‘The referral to MDM is quite labour intensive process particularly in private rooms So I have to make sure that all CT scans are done in the same practice, all the CTs are sent to the same radiologist to review them,” said one clinician. “I have to fill out extensive forms, include blood tests etc. as well, because of the nature of ILD, you can’t add the name and it just pops up, it’s quite labour intensive to get all the investigations together and doubly so if you’re taking it to another MDT somewhere else which I haven’t done often but some of my colleagues have. So, I think getting all the information together in one place and actually making the referral is a bit of a pain.”.

The study authors concluded that further development of telehealth offered the best prospects inequity to overcome the inequity in access to specialist IPF services, particularly in regional areas, especially for people living outside of metropolitan centres are required.

The results are published in Respirology.

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