A rapid referral circuit between primary care centres (CAPs) and the Bellvitge Pulmonary Interstitium Functional Unit (UFIP) has managed to reduce the time needed to diagnose pulmonary fibrosis, a rare and progressive respiratory disease that is often detected late, from 22 months to just 6 months.
The results, published in npj Primary Care Respiratory Medicine (Nature group), show that this model of coordination between levels of care not only accelerates diagnosis, but also improves the prognosis of affected people. Transplant-free survival at seven years increases by 14% in people referred through this preferential route.
The retrospective multicenter study, led by Bellvitge Hospital, Delta Primary and Community Care of the ICS and IDIBELL, has analyzed 726 people referred to UFIP between 2012 and 2015, with a minimum follow-up of five years. Of these, 112 were identified and referred directly from Primary Care through this preferential route.
Getting there earlier preserves lung function and expands treatment options
As explained by Dr. Guadalupe Bermudo, a specialist doctor at UFIP and the Pneumology Service of the Bellvitge Hospital, IDIBELL researcher and first author of the study, “people who go through the fast circuit arrive at the hospital with less lung involvement and more therapeutic options”.
People referred preferentially have better lung capacity when they arrive at the specialised unit (89.6% compared to 76.1% in the usual circuit), which makes it easier to start antifibrotic treatments earlier and improve the prognosis.
In more advanced cases, this early diagnosis also allows options such as lung transplantation to be prepared with more time.
At seven years, transplant-free survival is 14% higher in people referred through the rapid circuit (57.1%) compared to the usual circuit (43.6%).
“Diagnosing early means changing the trajectory of the disease,” says Dr. Maria Molina, head of the Bellvitge Pulmonary Interstitium Functional Unit, head of the Pneumology research group at IDIBELL and scientific director of IDIBELL and the CIBER of Respiratory Diseases (CIBERES). “Early diagnosis allows us to intervene in more treatable phases and improve the quality and life expectancy of the people served,” he adds.
A serious illness that is often diagnosed late
Pulmonary fibrosis is a rare and serious respiratory disease that causes progressive scarring of the lung. This rigidity hinders ventilation and the correct oxygenation of the blood, and generates a progressive sensation of suffocation.
Early symptoms, such as shortness of breath or persistent dry cough, are often confused with other, more common breathing problems, delaying diagnosis.
In Spain, it affects approximately 13 women and 20 men per 100,000 inhabitants.
A coordinated, territorial and replicable work model
The rapid circuit deployed in the Southern Metropolitan region includes training for Primary Care professionals to identify warning signs, direct coordination between radiology and the Bellvitge Pulmonary Interstitium Unit, preferential referral through a specific channel and a first hospital visit in less than a month.
This model makes it possible to detect the disease in its early stages, avoid repeated tests and ensure more efficient access to specialised assessments.
Dr. Elisabet Serra, a family doctor at CAP Just Oliveras in L’Hospitalet, highlights: “This circuit provides us with clear tools and criteria to identify suspected cases and refer them immediately.”
For his part, Dr. Ferran Ferrer, a family doctor at the El Prat Basic Health Area, stresses: “It is an operational, simple and effective model that avoids months or even years of going through different consultations before reaching specialized care.”
The results indicate that this model can be easily replicated in other territories and contribute to reducing inequalities in access to the diagnosis of complex respiratory diseases.
Bellvitge’s UFIP works with a multidisciplinary approach that integrates professionals from Pneumology, Diagnostic Imaging, Thoracic Surgery, Pathological Anatomy and Primary Care, following European standards in interstitial lung diseases.
This care model is complemented by new lines of innovation promoted by the Bellvitge Health Campus to further accelerate the diagnosis of interstitial lung diseases. These include the SEPI-IA project, led by Bellvitge Hospital together with various clinical and technological partners, which uses artificial intelligence applied to medical imaging to help detect pulmonary fibrosis early and reduce diagnostic inequalities between territories.
“The combination of fast clinical circuits, territorial coordination and artificial intelligence tools should allow us to diagnose these diseases earlier and better,” concludes Dr. Maria Molina.
The work is also part of the REMMA Bellvitge research programme, promoted by IDIBELL, aimed at improving the diagnosis of rare diseases in adults through coordinated care models and precision medicine tools.
About Bellvitge University Hospital
Bellvitge Hospital is a public, university, research and innovative hospital. With more than 5,200 expert and committed professionals, it is the local hospital for the citizens of L’Hospitalet and El Prat de Llobregat and a reference centre of maximum complexity for 2 million people throughout the southern axis of Catalonia. It is the Catalan health centre that performs the most complex surgery, especially oncological surgery, and is part of the Campus Salut Bellvitge, recognised by the Organisation of European Cancer Institutes (OECI) as a Comprehensive Cancer Centre for its excellence in cancer care, research and teaching. It integrates in its projects the orientation to improve the patient experience and networking with primary care and the surrounding hospitals. Oriented towards personalised medicine, it has the best genetic and imaging diagnostic tools for cancer and rare diseases, which are complemented by the High Precision Diagnostic Centre, which has the first PET/Magnetic Resonance Imaging in the Spanish healthcare network. It annually registers about 26,000 major surgery interventions, 39,000 discharges, 400,000 outpatient visits and around 100,000 diagnostic tests.
About Delta Primary and Community Care Management
The Delta Primary and Community Care Management (GAPiC) of the Catalan Institute of Health (ICS) offers diagnosis and care for the main acute and chronic health problems, health and social care, health promotion services, preventive, curative and rehabilitative care, home, urgent and continuous care, community health, sexual and reproductive health care and mental health care. It has more than 1,460 professionals working in the 20 Primary Care teams, the 3 territorial Paediatric Care teams and 7 support care units (Sexual and Reproductive Health Care, Mental Health Unit, Rehabilitation, Continuous Care and Territorial-based Emergencies, SDPI, PADES and Travel Care Unit), located in 7 municipalities in the Barcelonès and Baix Llobregat regions. The GAPiC Delta responds to the needs of more than 473,632 inhabitants. The GAPiC Delta works in a network with hospitals, mental health centres and intermediate care centres, and in coordination with the rest of the agents involved in the field of health, social and community health.
About IDIBELL
The Bellvitge Biomedical Research Institute (IDIBELL) is a research centre created in 2004 and specialising in cancer, neuroscience, translational medicine and regenerative medicine. It has a team of more than 1,500 professionals who, from 73 research groups, publish more than 1,400 scientific articles a year. IDIBELL is supported by the Bellvitge University Hospital and the Viladecans Hospital of the Institut Català de la Salut, the Institut Català d’Oncologia, the University of Barcelona and the City Council of L’Hospitalet de Llobregat. IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centres accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the HR Excellence in Research program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Centre of the AECC Scientific Foundation (FCAECC).