Travel Distance to Subspecialty Clinic and Outcomes in Patients with Fibrotic Interstitial Lung Disease by Johannson et al. Publicshed in Annals of American Thoracic Society (2022) https://doi.org/10.1513/annalsats.202102-216oc
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Lay Summary
Why We Did This Study:
The Interstitial Lung Disease (ILDs) are a group of lung diseases that cause inflammation and scar tissue in the lungs, often leading to chronic cough and shortness of breath. ILDs can be challenging to diagnose and treat, so patients often need specialized medical teams, which are typically found in large cities. As a result, patients who live in rural or remote areas must travel further and take more time to receive the same care as people living in or closer to cities. And it might be hard for them to travel far to attend these appointments.
Study Goals
The first goal of this study was to measure how far Canadian patients with interstitial lung diseases (ILDs) need to travel to reach specialty clinics for their care. The second goal was to see whether travel distance is linked to patient outcomes, such as a patient surviving or needing a lung transplant.
How The Study Was Done
Researchers used the Canadian Registry for Pulmonary Fibrosis (CARE-PF) to identify patients. CARE-PF is the largest database of ILD patients in the world, and people participate from 8 ILD clinic sites across Canada (CARE-PF LINK). From the CARE-PF database, researchers collected information about symptoms, quality of life measurements, breathing tests, treatments, and outcome information for each participant. Patients’ home postal codes were used to find where they lived, and to measure driving distance, in kilometres, to their ILD specialty clinic.
Findings
This study included 1,162 patients with ILD, and patients were divided into living near (within 70km from the clinic) or far (greater than 70km from the clinic). Patients who lived further away averaged a 3-hour drive to clinic. We found that patients who lived far away had less severe lung disease compared to people who lived closer to the clinics. But those who lived further away were more likely to get a lung transplant compared to patients who lived closer. Patients who lived far away also had a higher risk of dying than those who lived nearby. These results were more obvious in patients with connective tissue disease (autoimmune)-related ILD, compared to other diagnoses.
Interpretation
One possible reason for the results is that very sick patients who live far away may not be sent to the city for specialty care. For some, the long drive could make it too hard to attend appointments at specialty care clinics, especially in winter driving conditions. The long travel time can create financial barriers when considering driving costs or the need to stay in a hotel. These patients may also worry about running out of supplemental oxygen during travel, which may make them less willing or able to go to the clinic. This means some rural patients may not be get the care they need because of how far they live from the clinic.
Summary
The findings from this study suggest that ILD patients from rural or remote areas are not as likely to be sent to a specialty clinic for the care, compared to people living closer to the clinic. Standardized remote monitoring and virtual clinics could help improve care for rural patients and make care more equitable.
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