Caring for Rural Patients With Interstitial Lung Disease

Alison M. DeDent MAS, MD , Jessica E. Shore PhD, RN , Rebecca Bascom MD, MPH , Janell Reichuber APRN , Mary Beth Scholand MD , Ryan Boente MD , Anoop M. Nambiar MS, MD , Sonye K. Danoff MD, PhD , Franck Rahaghi MD, MHS , Tejaswini Kulkarni MD, MPH , Hyun Joo Kim MD , Pulmonary Fibrosis Foundation Rural Health Outreach Committee
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Abstract

Background

The Pulmonary Fibrosis Foundation Care Center Network (PFF-CCN) provides expertise in the diagnosis and management of interstitial lung diseases (ILDs); however, most centers are in urban areas. Little is known about access to ILD care for patients living in rural areas.

Research Question

What are the perspectives of PFF-CCN providers on the accessibility and provision of ILD care for rural patients?

Study Design and Methods

A mixed methods survey designed by the Pulmonary Fibrosis Foundation Rural Health Outreach Committee was distributed with weekly reminders to all 68 PFF-CCN sites between November 2021 and February 2022 through REDCap. The survey included 21 closed-ended questions that were analyzed using descriptive statistics and 3 open-ended questions that underwent thematic analysis. Before coding, free text responses were reviewed, and nearly all were sorted into 1 of 2 groups: barriers or facilitators to ILD care. Responses were then coded inductively and sorted into categories, followed by themes drawn from the data. Only 1 survey per PFF-CCN site was analyzed.

Results

A total of 68 PFF-CCN sites (providers) completed the survey (100% response rate). Of these, 57% of providers perceived that rural patients often experience delays in diagnosis compared with their urban counterparts, and 47% perceived they often have delays in ILD treatment. The following 3 themes emerged as barriers to ILD care for rural patients: poor access to care (73% of all coded barriers), limited resources (23%), and patient preferences and concerns (3%). Three themes emerged as facilitators to ILD care: local collaboration (49% of all coded facilitators), telemedicine (30%), and patient-centered care (21%).

Interpretation

PFF-CCN providers identified several important barriers and facilitators to care for rural patients with ILD occurring at the patient, provider, and health care system levels.
农村间质性肺病患者的护理
肺纤维化基金会护理中心网络(PFF-CCN)提供间质性肺疾病(ild)的诊断和管理方面的专业知识;然而,大多数中心都在城市地区。对于生活在农村地区的ILD患者获得治疗的情况知之甚少。研究问题:PFF-CCN提供者对农村患者ILD护理的可及性和提供有何看法?研究设计和方法由肺纤维化基金会农村健康外展委员会设计的一项混合方法调查于2021年11月至2022年2月期间通过REDCap每周提醒分发给所有68个PFF-CCN站点。调查包括21个封闭式问题,使用描述性统计进行分析,3个开放式问题进行专题分析。在编码之前,对自由文本回复进行审查,几乎所有回复都被分为两组中的一组:ILD护理的障碍或促进者。然后对回答进行归纳编码并分类,然后从数据中得出主题。每个PFF-CCN站点仅分析了1个调查。结果共有68家PFF-CCN站点(提供者)完成了调查,回复率为100%。其中,57%的医疗服务提供者认为,与城市患者相比,农村患者的诊断经常出现延误,47%的医疗服务提供者认为,他们的ILD治疗经常出现延误。以下3个主题成为农村患者ILD护理的障碍:难以获得护理(占所有编码障碍的73%)、资源有限(23%)和患者偏好和关注(3%)。三个主题成为ILD护理的促进因素:本地协作(占所有编码促进因素的49%)、远程医疗(30%)和以患者为中心的护理(21%)。pff - ccn提供者确定了在患者、提供者和卫生保健系统层面上对农村ILD患者进行护理的几个重要障碍和促进因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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