{
  "abstract": "Introduction Regional models of care using shared care and tiered delivery may tackle health inequalities for patients with interstitial lung disease (ILD) and provide high-standard care closer to home [ILD Care Pathway, One Voice ILD, April 2024]. The Merseyside ILD network have used a shared care tiered service delivery model for several years, with Aintree University Hospital (Tier 3) supporting Tier 1 and 2 sites across the region - see table 1. In anticipation of changes to ILD service delivery, we report the outcomes of shared care within our cohort.Methods We conducted a retrospective observational study of patients with idiopathic pulmonary fibrosis (IPF) and progressive fibrotic ILD (PF-ILD) started on antifibrotic (AF) therapy 01/01/2022–31/12/2023. We collected baseline demographics, spirometry, and outcomes, including AF discontinuation and mortality, until 01/01/2025. Patients were cohorted based on parent hospital tier, and outcomes compared using Kaplan Meier analyses.Results 275 patients commenced AF therapy through our ILD centre (mean age 72, 69% male, 68% on nintedanib). 60 (22%) were followed up by Aintree directly, 125 (45%) by a tier 2 site, and 90 (33%) by shared care with a tier 1 site. Patients with PF-ILD were significantly younger, with significantly lower FEV1, FVC, and TLCO at baseline compared to those with IPF. There was no difference in patient characteristics between tiers.After exclusion of patients who had physician-recommended AF discontinuation (e.g. due to transaminitis), 1-year adherence was 67% (95% CI 61–74%). While there was no difference in discontinuation rate between tiers, pirfenidone had a significantly higher discontinuation risk compared to nintedanib (HR 1.60, 95% CI 1.05–2.44, p=0.029).121 patients (44%) died between AF start and end of follow up, with 12-month survival estimated at 79% (95% CI 74–84%). There was no significant survival difference between tiers. Patients who discontinued their AF during the follow up period had a significantly increased mortality risk (HR 1.82, 95% CI 1.23–2.69, p=0.002).Abstract P25 Table 1Overview of services offered by tier status in Merseyside ILD serviceConclusions Our data suggest shared care tiered service delivery for AF delivery is safe, without difference in adherence or mortality between specialist and non-specialist sites. These findings support rollout of tiered service delivery within the UK.",
  "authors": [
    {
      "affiliations": [
        "University of Liverpool, Liverpool, UK"
      ],
      "name": "F Fyles"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "A McKinnon"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "S Agnew"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "J Sutcliffe"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "S Brooks"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "J Barnett"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "S McGarvie"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "A Simons"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "A Kwok"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "V Yioe"
    },
    {
      "affiliations": [
        "Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool, UK"
      ],
      "name": "LG Spencer"
    }
  ],
  "title": "P25 Impact of tiered service delivery model on antifibrotic adherence and mortality among patients with interstitial lung disease",
  "uid": "cc554684-8a35-5e15-976b-f1c61962f6d5"
}