Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists.
BMC Pulm Med
; 20(1): 58, 2020 Mar 04.
Article
em En
| MEDLINE
| ID: mdl-32131782
ABSTRACT
BACKGROUND:
Many individuals with cystic fibrosis (CF) die from respiratory failure without referral for lung transplant. Physician practices that may expedite, delay, or preclude referral, are poorly understood.METHODS:
Two parallel, web-based surveys focusing on lung transplant referral triggers and barriers, as well as pre-referral evaluation, were emailed to pulmonologists practicing in the New England region. One questionnaire was sent to CF providers (n = 61), and the second to general pulmonary providers practicing at the same institutions (n = 61).RESULTS:
There were 43 (70%) responses to the CF provider survey, and 25 (41%) responses to the general pulmonary ('non-CF') provider survey. Primary reasons for CF providers to refer their patients included rapidly declining lung function (91%) and a forced expiratory volume in 1 s (FEV1) below 30% predicted (74%). The greatest barriers to referral for both CF and non-CF providers included active tobacco use (65 and 96%, respectively, would not refer), and active alcohol or other substance use or dependence (63 and 80%). Furthermore, up to 42% of CF providers would potentially delay their referral if triple-combination therapy or other promising new, disease-specific therapy were anticipated. In general, non-CF providers perform a more robust pre-referral medical work-up, while CF providers complete a psychosocial evaluation in higher numbers. Across both groups, communication with lung transplant programs was reported to be inadequate.CONCLUSIONS:
Physician-level barriers to timely lung transplant referral exist and need to be addressed. Enhanced communication between lung transplant programs and pulmonary providers may reduce these barriers.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Encaminhamento e Consulta
/
Conhecimentos, Atitudes e Prática em Saúde
/
Transplante de Pulmão
/
Fibrose Cística
/
Hipertensão Pulmonar
Tipo de estudo:
Prognostic_studies
/
Qualitative_research
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
BMC Pulm Med
Ano de publicação:
2020
Tipo de documento:
Article