Impact of Tiered Service Delivery Model on Antifibrotic Adherence and Outcomes Among Patients With Interstitial Lung Disease
- 1Liverpool Interstitial Lung Disease Service Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust Liverpool UK
- 2University of Liverpool Liverpool UK
Abstract
Introduction: Within England, Interstitial Lung Disease (ILD) services are in the process of adopting tiered ‘shared‐care’ service delivery to address increased demand. There are currently no data evaluating this model. We report on clinical outcomes of our Merseyside shared‐care ILD service delivery over 2 years.
Methods: We conducted a retrospective observational study of adults with ILD started on antifibrotic therapy through our regional centre from 01/01/2022 to 31/12/2023. Alongside demographics and clinical data, we reviewed mortality and antifibrotic adherence. Patients were grouped on tier status of follow‐up site: Tier 3 were Specialist ILD Network Hubs, Tier 2 were specialist centres with ILD nurse access, and Tier 1 were general respiratory centres with remote support from Tier 3 ILD nurses.
Results: A total of 275 patients were commenced on antifibrotic therapy (mean age 72.3, 69% male, 68% on nintedanib), with comparable cohorts across tiers. Twelve‐month all‐cause antifibrotic discontinuation was 40%, and was associated with increased age (HR 1.04, p = 0.001), but not with tier status of follow‐up site (p = 0.084). Twelve‐month survival was 79%, and was not significantly different between tiers (p = 0.3). Progressive fibrotic ILD was associated with increased mortality risk, whereas higher BMI and baseline lung function were associated with reduced mortality. Patients on pirfenidone were more likely to have intolerable side effects (HR 1.60, p = 0.029), and patients stopping antifibrotics had a significantly increased mortality risk (adjusted HR 2.18, p = 0.003).
Conclusion: This retrospective real‐world study suggests that a tiered approach to ILD service delivery—provided non‐specialist sites are given appropriate support—can be a safe and effective model.
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BibTeX
@article{fyles2026impact,
title = {{Impact of Tiered Service Delivery Model on Antifibrotic Adherence and Outcomes Among Patients With Interstitial Lung Disease}},
author = {Fred Fyles and Alice McKinnon and Sarah Agnew and Joanne Sutcliffe and Sarah Brooks and Jacqueline Barnett and Siobhan McGarvie and Annelise Simons and Apollo Kwok and Vernoica Yioe and Lisa G. Spencer},
journal = {The Clinical Respiratory Journal},
year = {2026},
month = oct,
doi = {10.1111/crj.70239},
url = {https://doi.org/10.1111/crj.70239},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Impact of Tiered Service Delivery Model on Antifibrotic Adherence and Outcomes Among Patients With Interstitial Lung Disease
AU - Fred Fyles
AU - Alice McKinnon
AU - Sarah Agnew
AU - Joanne Sutcliffe
AU - Sarah Brooks
AU - Jacqueline Barnett
AU - Siobhan McGarvie
AU - Annelise Simons
AU - Apollo Kwok
AU - Vernoica Yioe
AU - Lisa G. Spencer
PY - 2026
DA - 2026/10/25
JO - The Clinical Respiratory Journal
DO - 10.1111/crj.70239
UR - https://doi.org/10.1111/crj.70239
AB - Introduction: Within England, Interstitial Lung Disease (ILD) services are in the process of adopting tiered ‘shared‐care’ service delivery to address increased demand. There are currently no data evaluating this model. We report on clinical outcomes of our Merseyside shared‐care ILD service delivery over 2 years. Methods: We conducted a retrospective observational study of adults with ILD started on antifibrotic therapy through our regional centre from 01/01/2022 to 31/12/2023. Alongside demographics and clinical data, we reviewed mortality and antifibrotic adherence. Patients were grouped on tier status of follow‐up site: Tier 3 were Specialist ILD Network Hubs, Tier 2 were specialist centres with ILD nurse access, and Tier 1 were general respiratory centres with remote support from Tier 3 ILD nurses. Results: A total of 275 patients were commenced on antifibrotic therapy (mean age 72.3, 69% male, 68% on nintedanib), with comparable cohorts across tiers. Twelve‐month all‐cause antifibrotic discontinuation was 40%, and was associated with increased age (HR 1.04, p = 0.001), but not with tier status of follow‐up site (p = 0.084). Twelve‐month survival was 79%, and was not significantly different between tiers (p = 0.3). Progressive fibrotic ILD was associated with increased mortality risk, whereas higher BMI and baseline lung function were associated with reduced mortality. Patients on pirfenidone were more likely to have intolerable side effects (HR 1.60, p = 0.029), and patients stopping antifibrotics had a significantly increased mortality risk (adjusted HR 2.18, p = 0.003). Conclusion: This retrospective real‐world study suggests that a tiered approach to ILD service delivery—provided non‐specialist sites are given appropriate support—can be a safe and effective model.
SN - 1752-6981
SN - 1752-699X
ER -