An email referral system between primary care centers and Bellvitge Hospital has reduced the diagnosis time for pulmonary fibrosis in the Regió Metropolitana Sud from two years to six months. The circuit has already been validated in a study signed by the hospital itself, the Atenció Primària i Comunitària Delta of the Institut Català de la Salut, and IDIBELL.
The improvement cuts a very long wait in a disease whose window of action conditions the prognosis. The change not only speeds up the first specialized visit but also avoids chain delays that could leave patients who could still benefit from a lung transplant out of therapeutic options.
Bellvitge schedules appointments within a month for cases detected by primary care
The new model starts with early detection in the CAPs. Primary care professionals have received training to identify signs of suspicion such as a chronic dry cough lasting between six and eight weeks in patients aged 40 to 50, usually smokers or with a history as welders or construction workers, along with shortness of breath.
When that pattern appears, the referral no longer follows the usual circuit of successive interconsultations and arrives directly by email to Bellvitge Hospital. Based on that alert, the hospital center schedules an in-person appointment for the patient within a month.
Elisabet Serra, a family doctor at the Centre d'Atenció Primària Sanfeliu in Sant Feliu de Llobregat, describes the process that was being avoided.
"The pulmonologist first takes time to respond to the interconsultation where we explain the patient's case. Then, if they want to see them in person, they schedule an appointment, which involves more weeks of delay. And if they assess that it could be fibrosis, they send them to the specialized unit at Bellvitge. All of this means weeks of delay." - Elisabet Serra, family doctor, Centre d'Atenció Primària Sanfeliu de Sant Feliu de Llobregat
This chain of steps explained why the diagnosis could be delayed for up to two years. With the new circuit, the timeframe drops to six months for a pathology where time determines a large part of the treatment possibilities.
Early diagnosis allows for longer survival and consideration of a transplant
Pulmonary fibrosis requires action before the damage is irreversible. Lupe Bermudo, a pulmonologist at the Functional Unit of Pulmonary Interstitium of Bellvitge Hospital, maintains that treatment can extend survival up to 10 years, compared to a prognosis of three to five years of life without treatment.
"It really changes the course of the disease. These are diseases that, when there is established fibrosis, the prognosis is serious. We are talking about the fact that without treatment the prognosis can be 3 to 5 years of life, and with treatment we can go up to 10 years." - Lupe Bermudo, pulmonologist, Functional Unit of Pulmonary Interstitium of Bellvitge Hospital
Early diagnosis also allows for the study of lung transplantation, the only curative treatment available. This option is reserved for patients under 65 years of age and can be ruled out if the disease is detected when lung capacity is already severely deteriorated.
Bermudo specifies that delay can close this therapeutic avenue even before the patient is evaluated.
"If it is diagnosed in a late stage where the patient no longer has sufficient lung capacity or if it is detected too late by years, we can no longer consider this option for the patient. So it is a great therapeutic option that we lose." - Lupe Bermudo, pulmonologist, Functional Unit of Pulmonary Interstitium of Bellvitge Hospital
The coordinated work model is already in operation in the Regió Metropolitana Sud, and the driving teams want to extend it to other territories. The study that has validated the circuit has been published by Bellvitge Hospital, the Atenció Primària i Comunitària Delta of the Institut Català de la Salut, and IDIBELL.