Introduction
Interstitial lung disease (ILD) management has significantly changed during the COVID-19 pandemic and use of telehealth has increased.1 2 The British Lung Foundation and UK National Health Service recommended that patients with ILD be ‘shielded’ to prevent contracting COVID-19.3 COVID-19 impacted healthcare for patients with ILD by restricting access to diagnosis, disabling monitoring disease severity, progression and adverse effects from medication. The burden put on patients with ILD following COVID-19 is high, and there is an urgent need for a contemporary approach in ILD management.4 5 Telehealth may help overcome access barriers for patients with ILD and those unable to come to hospital in person due to lack of transportation.6 Development of home spirometry as a valid monitoring tool,7 drug monitoring and assessment of side effects,8 can support other services remotely such as local oxygen services, general practitioners and secondary care physicians, but using a combined approach with patient and care provider in tele link with specialist centre.1 8–10 Using a combined approach with patient and care provider in tele link with specialist centre will be critical for success.1 6 11–13 Monitoring symptoms and physiological parameters using remote monitoring technology may allow early detection of exacerbation, which may reduce hospitalisation and decrease healthcare costs.1 11 Although most published studies have been in patients with chronic obstructive pulmonary disease (COPD),14–17 telehealth in ILD has also been explored. Studies have shown a great potential of remotely monitoring parameters, such as heart rate, respiratory rate, oxygen level, activities and lung function using home-based technologies and equipment.6 7 10 18–25 Results have been very promising not only for e-consultation, but also for monitoring and detecting disease progression and or exacerbation.1 25
ILD is a heterogeneous group that encompasses approximately 200 different types of lung disease that may cause inflammation and/or scarring of the lung.26 27 Idiopathic pulmonary fibrosis (IPF) is specific type characterised by severe breathlessness and poor prognosis of unknown aetiology.27 28 Richeldi et al29 are the only approved antifibrotic medications, which have been shown to slow IPF progression.30 Thus, prediction of disease course and mortality is crucial for clinicians and patients. Patients with ILD, specifically those with IPF, may experience acute exacerbation or ‘flare’ that may cause severe distress and rapid disease progression.31 Additionally, the use of forced vital capacity (FVC) declines as a validated end point to identify significant treatment response in IPF necessitates large cohorts and lengthy longitudinal studies.32 Conversely, domiciliary and daily measures of symptoms and physiological parameters such as spirometry may reduce length of time, size and cost of clinical trials.7 33
Although there is a growing body of research1 6 7 9–11 18–20 22 34–37 focusing mainly on feasibility and reliability of in-home spirometry, further data are limited on the prevalence and utility of telehealth to detect disease exacerbation and/or progression. Telehealth utility to remotely monitor symptoms and physiological parameters may allow prediction of disease progression in ILD. Previous studies1 11 have shown that in-home monitoring of FVC was predictive for disease progression. Furthermore, a Japanese study has shown that SpO2 might predict disease prognosis.38 Real-time continuous monitoring may also allow prediction of personal trajectory and improve future care.6 18
In support of this, studies8 18 have shown the potential benefit in patients with ILD of monitoring quality-of-life, medication use and disease course.1 10 11 Telehealth was introduced as a remote solution to continue to provide necessary healthcare services and support patients with ILD. It was also expanded to provide real-time monitoring and to detect disease exacerbation and progression. Recently, Telehealth has been shown to be feasible and reliable, and one study specifically explored how telehealth successfully detected exacerbations before symptoms began.6 Despite these significant findings, research understanding clinicians’ perceptions of telehealth in patients with ILD are limited.
Our goal was to conduct a global survey to understand from healthcare professionals, what approaches of ILD care are most appropriate for telehealth and simultaneously most beneficial to patients with ILD. We approached physicians and non-physicians to better understand variability in outcomes. We hope that this would help to understand physicians’ perspectives as well as perspectives of nurses and allied health professions towards telehealth useability, effectiveness and utility. All clinicians deliver healthcare services and provide care to patients including using technologies, for example, homes, doctor’s offices, clinics and hospitals. We sought to have a better understanding of the current practices of ILD care, the extent of use and to gain understanding of the barriers from clinicians’ perspectives that may limit the adaptation of telehealth for patients with ILD.