Creation of a Multidisciplinary Interstitial Lung Disease Clinical Care Team

Document Type

Conference Proceeding

Publication Date

5-17-2022

Publication Title

Am J Respir Crit Care Med

Abstract

Introduction: Interstitial Lung Disease (ILD) is a diagnosis that encompasses a diverse range of over 200 diseases in which there is chronic inflammation within the lung and/or varying degrees of lung fibrosis. Due to the nature of the disease state and the use of high-risk medications, there is a need for close monitoring and support. Patients value a multidisciplinary approach with the hope of improving understanding of their disease. ILD program leaders and patient focus groups expressed the desire for patient-centered care and support for living and coping with ILD. Methods: Prior to the expansion of the team, the ILD providers delivered initial medication education, preformed laboratory monitoring, and conducted medication monitoring visits. The ILD nurse specialist (ILD-RN) processed high risk medication starts, provided patient education and managed refills and triaged side effect phone calls. The roles of providers were revised to streamline care and focus responsibilities on areas of individual expertise (Table 1). Educational meetings were conducted to train and educate stakeholders (Table 1) on the medications and protocols. The roles were redefined for high-risk medication handling of prescriptions, prior authorizations, foundation assistance applications, refills, side effects, adherence, and monitoring. The team established multidisciplinary clinical ILD team meetings weekly to discuss patients. Patients were engaged in this process when notified by the provider that the team would aid in support with medication education, access, and management. Protocols were created to address lapses in adherence with office visits & lab monitoring, and side effects. ILD providers were mandated to use this system. EMR templates and time points of documentation were also created to improve infrastructure. Results: The expansion of the multidisciplinary team provided a mechanism to follow ILD patients prescribed either antifibrotic or steroid-sparing agents. The addition of the social worker and pharmacist to the team created time for patient visits and patient education. Team members expressed support of the multidisciplinary approach. The financial incentive of in-sourcing prescriptions serves as a source of downstream revenue, providing support for the hiring and maintaining of team members. Conclusions: We describe the expansion and implementation of a multidisciplinary approach to the care of ILD patients. This model draws on prior literature which supports the use of multidisciplinary care from a provider and patient perspective. Adopting this team dynamic within other specialty clinics should be considered to improve patient satisfaction, allow each team member to practice more efficiently, and ultimately optimize patient management.

Volume

205

Issue

1

First Page

A3958

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