Background: Patients with pulmonary fibrosis are often referred to specialist interstitial lung disease (ILD) centres in England for investigation, multidisciplinary diagnosis and management. In the UK, it can take an average of 18 weeks from referral to a specialist centre to initiation of antifibrotic therapy. Ongoing care involves regular hospital visits, on average 4 per year, which can be challenging due to dyspnoea and long distance travel. A pilot study was undertaken to observe the impact of shared management of these patients with a district general hospital.

Methods: Patients were reviewed by a respiratory clinician at the district general hospital. All investigations were undertaken locally and patients thought to have pulmonary fibrosis were discussed virtually with the tertiary specialist ILD multidisciplinary team. Antifibrotic therapy was initiated remotely and all ongoing reviews were undertaken at the local general hospital and/or virtually.

Results: 12 patients followed the shared management pathway over 14 months. There was an average waiting time of 3 days from referral to specialist ILD multidisciplinary discussion and diagnosis and 17 days until antifibrotic initiation. All monitoring of disease, response to treatment and supportive care was undertaken locally. Based on an average reduction of 4 car journeys per patient per year to the ILD specialist centre, 362 miles or 86.67 kilograms of carbon dioxide equivalent were saved.

Conclusions: Shared management can improve time to multidisciplinary diagnosis, accessibility to antifibrotics and reduce environmental impact.