Well begun is half done, which is certainly true for the treatment of interstitial lung disease (ILD). Early diagnosis of idiopathic pulmonary fibrosis (IPF), one of the most common forms of ILD, has become even more important with the development of new treatment options. To investigate how quickly IPF patients are referred to tertiary care, Finnish researchers analyzed referral letters. Their findings point to important steps that can be taken to shorten the delay from symptom onset to referral.
According to the researchers, they are the first to have evaluated the referral practice of IPF patients to tertiary care through referral letters. The referral to tertiary care is important, because delayed access to tertiary care is associated with higher mortality, independently from disease severity. The researchers analyzed 95 Finnish referral letters of patients with IPF. More than half of the referral letters originated from primary health care. Although this suggests that physicians in primary health care seem to suspect ILDs quite well, there were also certain common shortcomings in the referral letters.
The referring physicians also often forgot to supply information of occupational history
The researchers conclude, among other things, that the content of the anamnesis was often inadequate. A history of smoking was missing in 58% of cases, even though this is one of the most important causes of chronic lung diseases. The referring physicians also often forgot to supply information of occupational history and an evaluation of exposures during working life. The researchers think that the referring doctor might ignore the occupational history due to the advanced age of patients. It is, however, crucial to remember that some exposures may represent a health hazard only after a long delay, like asbestos.
The mean time from onset of symptoms to referral was 1,5 years, which is relatively short for ILDs: according to other studies, the mean delay from symptom onset to diagnosis is 2,2 years. The researchers do think that referral time can be shortened and that the quality of the referral letters can be improved. They argue for providing ILD information to both doctors and patients. On the one hand, providing general practitioners with more information of ILDs might shorten the delay from symptom onset to referral. And on the other hand, the researchers argue that provision of more easy-to-understand information about ILDs to the general public might also shorten the delay from symptom onset to referral. Together, measures like these can hopefully tackle this huge barrier in the treatment of ILD.