Multidisciplinary virtual management of pulmonary nodules

IF 10.4 2区 医学 Q1 RESPIRATORY SYSTEM Pulmonology Pub Date : 2024-05-01 DOI:10.1016/j.pulmoe.2021.12.003
D. Polanco , J. González , E. Gracia-Lavedan , L. Pinilla , R. Plana , M. Molina , M. Pardina , F. Barbé
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Abstract

Introduction and objectives

Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines.

Materials and methods

Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up.

Results

A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm).

Conclusions

During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.

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肺结节的多学科虚拟管理。
导言和目标:多学科结节诊所可提供高质量的护理,并有利于遵守指南。虚拟医疗在提高患者满意度的同时,也显示出节约成本的优势。我们的目的是描述多学科虚拟肺结节门诊第一年的运行情况、评估人群和做出的决定。其次,在出院患者中,我们旨在分析他们在我们开展会诊之前的随访情况,评估其对指南的遵守情况:观察性研究,包括在虚拟肺结节诊所(VLNC)(2018 年 3 月至 2019 年 3 月)接受评估的所有患者。记录了临床和放射学数据。根据 2017 年弗莱施纳协会指南的建议,分为随访、出院或转诊至肺癌会诊。出院患者根据是否遵守之前的治疗指南,分为充分随访、延长随访和无指征随访:共纳入了 365 名患者(58.9% 为男性,中位年龄为 64.0 岁)。64%的患者有吸烟史,23%的患者患有慢性阻塞性肺病(COPD)。大多数结节为实性(87.4%)和多发性(57.5%)。中位直径为 6.00 毫米。43.8%的患者在首次VLNC评估后出院。其中,27.5%的患者接受了适当的后续治疗,但66.9%的患者治疗效果不佳。接受长期随访的患者(33.1%)年龄较大(67.0 岁对 60.5 岁),结节较大(6.00 毫米对 5.00 毫米)。未指定随访的患者(33.8%)多为非吸烟者(77.8% 对 31.8%),结节较小(4.00 毫米对 5.00 毫米):VLNC运行一年来,评估了肺癌发病风险的相关人群,对他们的管理应谨慎,并遵守相关指南。在 VLNC 首次评估后,约有二分之一的患者出院。值得注意的是,以前对出院患者的随访发现,他们对指南的遵守情况很差,有明显的过度管理倾向。
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来源期刊
Pulmonology
Pulmonology Medicine-Pulmonary and Respiratory Medicine
CiteScore
14.30
自引率
5.10%
发文量
159
审稿时长
19 days
期刊介绍: Pulmonology (previously Revista Portuguesa de Pneumologia) is the official journal of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia/SPP). The journal publishes 6 issues per year and focuses on respiratory system diseases in adults and clinical research. It accepts various types of articles including peer-reviewed original articles, review articles, editorials, and opinion articles. The journal is published in English and is freely accessible through its website, as well as Medline and other databases. It is indexed in Science Citation Index Expanded, Journal of Citation Reports, Index Medicus/MEDLINE, Scopus, and EMBASE/Excerpta Medica.
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