Hambly Nathan, Goodwin Sarah, Aziz-Ur-Rehman Afia, Makhdami Nima, Ainslie-Garcia Margaret, Grima Daniel, Cox Gerard, Kolb Martin, Fung Diana, Cabalteja Czerysh, DeMarco Patricia, Moldaver Daniel
Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Thorac Dis. 2019 Dec;11(12):5547-5556. doi: 10.21037/jtd.2019.11.41.
Canadian and international guidelines recommend specialized, multidisciplinary teams for the treatment of patients with idiopathic pulmonary fibrosis (IPF). The objective of this cross-sectional clinical study was to investigate the effect of a care coordinator on IPF patient satisfaction and quality of life.
Forty IPF patients were enrolled from the practices of two physicians (n=20/physician), with either low (LCU) or high-coordinator use (HCU). Patient satisfaction was measured with modified FAMCARE and IPF Care UK Patient Support Program (UK-CARE) surveys. Health related quality of life (HRQoL) was assessed with the living with IPF impacts (L-IPFi) survey. An economic model assessed the impact of the coordinator; staff surveys informed patient management requirements, and costs were derived from published literature.
Patient satisfaction was similar between the clinics; a trend (P=0.1) towards increased satisfaction among HCU patients was observed. Patients in the HCU clinic reported increased satisfaction (P<0.05) with their current care compared with care prior to joining the tertiary-care clinic, while LCU patients did not. IPF patient HRQoL did not differ between clinics. The coordinator was estimated to alleviate approximately 30% of a physician's IPF-related work load, and to facilitate the care of more patients per physician. Modelled estimates suggest the coordinator lead to annual cost-savings of $137,212.
Reliance upon a coordinator during routine management of IPF patients may improve patient satisfaction, spare physician time and lead to annual cost-savings. Future studies should examine the impact of a coordinator on healthcare resource utilization.
加拿大及国际指南推荐采用专业的多学科团队来治疗特发性肺纤维化（IPF）患者。这项横断面临床研究的目的是调查护理协调员对IPF患者满意度和生活质量的影响。
从两位医生的诊所招募了40名IPF患者（每位医生各20名），这些患者分为低协调员使用组（LCU）和高协调员使用组（HCU）。通过改良的FAMCARE和英国IPF护理患者支持计划（UK-CARE）调查来测量患者满意度。采用IPF生活影响（L-IPFi）调查评估健康相关生活质量（HRQoL）。一个经济模型评估了协调员的影响；员工调查为患者管理要求提供了信息，成本则来自已发表的文献。
两个诊所的患者满意度相似；观察到HCU组患者的满意度有上升趋势（P=0.1）。与加入三级护理诊所之前接受的护理相比，HCU诊所的患者对当前护理的满意度有所提高（P<0.05），而LCU组患者则没有。两个诊所的IPF患者HRQoL没有差异。据估计，协调员可减轻医生约30%的IPF相关工作量，并使每位医生能够护理更多患者。模型估计表明，协调员可实现每年节省成本137,212美元。
在IPF患者的常规管理中依赖协调员可能会提高患者满意度、节省医生时间并实现年度成本节约。未来的研究应考察协调员对医疗资源利用的影响。
