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width="1.25rem" xmlns="http://www.w3.org/2000/svg"><polyline points="6 9 6 2 18 2 18 9"></polyline><path d="M6 18H4a2 2 0 0 1-2-2v-5a2 2 0 0 1 2-2h16a2 2 0 0 1 2 2v5a2 2 0 0 1-2 2h-2"></path><rect x="6" y="14" width="12" height="8"></rect></svg></a></button></div></div><div><div class="flex flex-wrap"><p class=" text-primary font-semibold">News</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1"></div><p class=" text-primary font-semibold">Article</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1 "></div><time class="text-gray-500 " dateTime="2024-10-30T16:21:32.927">October 30, 2024</time></div><h1 class="text-[26px] font-medium leading-8">Low Pulmonary Rehabilitation, Palliative Care Referrals for Patients With IPF Persist</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/brooke-mccormick">Brooke McCormick</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Low Pulmonary Rehabilitation, Palliative Care Referrals for Patients With IPF Persist" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button 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background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div><style> video::cue { display: inline; background-color: #b8dcf6; padding: 2px 2px; } audio { height: 40px; } .rhap_container { width: 300px !important; border-radius: 100px !important; height: 40px !important; box-shadow: 0px 0px 2px 2px rgba(0,0,0,0.1); } .rhap_progress-section { width: 150px; margin-left: 35px; } .rhap_controls-section { position: relative; bottom: .75rem; } .rhap_time { font-size: 12px; color: rgb(0,55,103); } .rhap_progress-bar { color: rgb(0,55,103) !important; } .rhap_progress-filled { background-color: rgb(0,55,103) !important; } .rhap_progress-indicator { height: 15px; width: 5px; top: -5px; margin-left: 1px; background-color: rgb(0,55,103) !important; } .rhap_repeat-button { display: none; } .rhap_volume-bar, rhap_volume-button, .rhap_volume-indicator { background: rgb(0,55,103) !important; } .rhap_volume-bar { height: 2px; width: 35px; position: relative; left: 22px; bottom: 21px; } .rhap_volume-button { // width: 5px; // height: 5px; flex: 0 0 26px; position: relative; left: 22px; bottom: 21px; } .rhap_volume-button svg { height: 18px; width: 18px; } .rhap_volume-indicator { height: 8px; width: 8px; top: -2.75px } .rhap_button-clear { color: rgb(0,55,103) !important; } .rhap_play-pause-button { color: rgb(0,55,103) !important; font-size: 30px !important; width: 30px !important; height: 30px !important; position: relative; right: 90px; bottom: 22px; } .rhap_main-controls button { color: rgb(0,55,103) !important; } audio::-webkit-media-controls-play-button, video::-webkit-media-controls-play-button { -webkit-appearance: media-play-button; color: #b8dcf6; } audio::-webkit-media-controls-panel { background-color: white !important; color: #000; } audio::-webkit-media-controls-current-time-display, audio::-webkit-media-controls-time-remaining-display { font-size: 12px; } </style></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"></div><div class="w-full flex flex-col px-4 py-4 border-t border-b border-solid border-gray-400 my-4 "><h3 class="text-primary text-xl font-semibold">Key Takeaways</h3><ul class="list-disc px-8"><li class="py-2 "> Referrals to PR and PC for IPF patients in England remain low, despite evidence of their benefits. </li><li class="py-2 "> Smoking history, COPD diagnosis, and male sex were positively associated with PR referrals. </li><li class="py-2 hidden"> Older age, dementia, and ischemic heart disease were linked to non-referral for PR and PC. </li><li class="py-2 hidden"> The study emphasizes the need for increased investment in PR and PC services to meet demand.</li></ul><span class="text-xs font-bold text-primary underline cursor-pointer mt-2 ml-4">SHOW MORE</span></div><p class="py-2 mb-2 text-sm italic text-gray-600">Despite proven benefits, referrals to pulmonary rehabilitation and palliative care for patients with idiopathic pulmonary fibrosis (IPF) in England remain significantly lower than for other respiratory conditions.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><p class="pb-2">Despite improvements over the past decade, referrals to pulmonary rehabilitation (PR) programs and palliative care (PC) services among patients with <a target="_blank" href="https://www.ajmc.com/compendium/ipf">idiopathic pulmonary fibrosis (IPF)</a> in England remained low in 2019, according to a study published in <a rel="nofollow noreferrer noopener" target="_blank" href="https://www.nature.com/articles/s41533-024-00387-6"><em>NPJ Primary Care Respiratory Medicine</em></a>.<sup class="text-inherit">1</sup></p><p class="pb-2"></p><p class="pb-2">Typically, once IPF is diagnosed, the <a rel="nofollow noreferrer noopener" target="_blank" href="https://link.springer.com/article/10.1007/s12325-018-0693-1">prognosis</a> is poor, with an average survival time of just 3 to 5 years among those in the United Kingdom (UK) who did not receive treatment.<sup class="text-inherit">2</sup> However, increasing research supports a holistic approach to managing those diagnosed with IPF, with PR and PC considered important components of such an approach.<sup class="text-inherit">1</sup></p><p class="pb-2"></p><p class="pb-2">Originally, PR was <a rel="nofollow noreferrer noopener" target="_blank" href="https://journals.lww.com/jcrjournal/fulltext/2018/09000/impact_of_pulmonary_rehabilitation_on_exercise.1.aspx">created</a> to support patients with chronic obstructive pulmonary disease (COPD), but, in recent years, evidence has emerged of its benefits among those with IPF.<sup class="text-inherit">3</sup> Similarly, several studies have demonstrated that access to integrated PC services improves the quality of life of patients with IPF.<sup class="text-inherit">1</sup></p><p class="pb-2"></p><p class="pb-2">Conversely, the researchers noted that PR and PC service provision is poor among those with IPF, with referral rates typically much lower than those with other respiratory conditions, like COPD or lung cancer. National registry data from several countries, including the US, Germany, and Spain, <a rel="nofollow noreferrer noopener" target="_blank" href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10501708/">demonstrated</a> that less than 20% of those diagnosed with IPF are offered a PC referral and less than 10% attend PR.<sup class="text-inherit">4</sup></p><p class="pb-2"></p><p class="pb-2">To add to this data, the researchers conducted a study to examine UK trends in referrals to PR and PC for patients with IPF.<sup class="text-inherit">1</sup> They also investigated demographic and patient factors linked to referrals. </p><div class=""><div style="width:40%;float:right;max-width:525px;margin:0 0 1.5rem 1.5rem;clear:both;cursor:" class=" figure"><div class="flex-none relative text-center"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%275500%27%20height=%273667%27/%3e"/></span><img alt="IPF written on whiteboard | Image Credit: Vitalii Vodolazskyi - stock.adobe.com" title="IPF written on whiteboard | Image Credit: Vitalii Vodolazskyi - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain"/><noscript><img alt="IPF written on whiteboard | Image Credit: Vitalii Vodolazskyi - stock.adobe.com" title="IPF written on whiteboard | Image Credit: Vitalii Vodolazskyi - stock.adobe.com" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8803ff6f9490c9e1e62494b683ed2e8b961e7610-5500x3667.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 1x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F8803ff6f9490c9e1e62494b683ed2e8b961e7610-5500x3667.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain" loading="lazy"/></noscript></span></div><div id="image-caption" class="text-gray-500 italic"><div class="blockText_blockContent__TbCXh"><p class="pb-2">Referrals to pulmonary rehabilitation and palliative care for patients with idiopathic pulmonary fibrosis remain significantly lower than for other respiratory conditions. | Image Credit: Vitalii Vodolazskyi - stock.adobe.com</p></div></div><div class="top-[-100%] block w-[1px] transition-opacity duration-500 ease-in-out opacity-0 overflow-hidden"><img class="m-auto absolute inset-0 max-w-[0%] max-h-[0%] border-[3px] border-solid border-white shadow-[0px_0px_8px_rgba(0,0,0,0.3)] box-border transition ease-in-out duration-500" src="https://cdn.sanity.io/images/0vv8moc6/ajmc/8803ff6f9490c9e1e62494b683ed2e8b961e7610-5500x3667.jpg?fit=crop&auto=format"/></div></div><style> #image-caption p{ font-size: 12px; max-width: 525px; margin: 0 auto; text-align: center; } </style></div><p class="pb-2">The study <a rel="nofollow noreferrer noopener" target="_blank" href="https://academic.oup.com/ije/article/48/6/1740/5374844?login=false">used</a> the Clinical Practice Research Datalink (CPRD) Aurum database, a curated set of patient-level electronic health records from 1345 participating UK general practitioner (GP) practices<sup class="text-inherit">5</sup>; it is representative of the UK population in terms of age, ethnicity, and sex.</p><p class="pb-2"></p><p class="pb-2">Eligible patients were registered at linkage-eligible CPRD Aurum GP practices and diagnosed with IPF on or after the start of the study period (January 1, 2010) but before the end of the study period (December 31, 2019).<sup class="text-inherit">1</sup> They also needed to be at least 40 years old at the time of their IPF diagnosis, meet CPRD-defined data quality criteria, and have at least 1 year of continuous registration with their current GP before their IPF diagnosis.</p><p class="pb-2"></p><p class="pb-2">For each patient, follow-up began on the latest of the following dates: the start of the study period, the date of registration with their GP practice, the date of their 40th birthday, or the date of IPF diagnosis. Then, follow-up concluded on the earliest of the following dates: the end of the study, the date of death, or the last day of either practice registration or data collection.</p><p class="pb-2"></p><p class="pb-2">The researchers considered patients to have been referred to PR or PC if their primary care record included evidence that they had been considered and/or offered a referral to PR or PC after their IPF diagnosis and within their follow-up period. Additionally, the selected risk factors comprised demographic characteristics, smoking status, lifestyle characteristics, and the presence of selected comorbid diseases; these included COPD, lung cancer, and asthma.</p><p class="pb-2"></p><p class="pb-2">The study population consisted of 17,071 patients with IPF, most of whom were male (62.6%), White (92.3%), and had a history of smoking (88.5%). The median age at diagnosis was 76.7 years, and the most common comorbidities were ischemic heart disease (IHD; 27.2%), depression/anxiety (25.7%), and diabetes (23.7%).</p><p class="pb-2"></p><p class="pb-2">During follow-up, 2042 patients (12.0%) were referred to PR. More men than women were referred to PR (13.0% vs 10.2%), and nearly half of all referrals occurred in those between the ages of 70 and 79 (43.6%). Also, 22.3% of those referred were current smokers. Compared with the non-referral group (non-PR group), comorbidities like COPD, asthma, and depression/anxiety, were more common among the referral group (PR group). For example, 40.9% of the PR group vs 12.9% of the non-PR group also had COPD.</p><p class="pb-2"></p><p class="pb-2">Through temporal analyses, the researchers discovered that, in 2010, only 1.2% of patients were offered PR (15 of 1246 patients). By 2019, this proportion rose to 6.5% (574 of 8811 patients). Although referral proportions were higher in those who received a previous diagnosis of COPD, they observed a steady referral proportion increase over time, even among those without a COPD diagnosis.</p><p class="pb-2"></p><p class="pb-2">After adjusting for potential confounders, smoking history, a prior COPD diagnosis, and male sex were strongly positively associated with PR referral. Conversely, potential contributory factors to non-referral include older age (over 80 years old), co-existing dementia, and the presence of IHD.</p><p class="pb-2"></p><p class="pb-2">On the other hand, 19.4% (2159 men; 1156 women) of the study population were referred to PC support services; nearly 80% of referrals occurred in those over 70 years old. Lung cancer and pre-existing cardiovascular conditions were among the comorbidities more prevalent among the PC group. Of those diagnosed with lung cancer (n = 137; 0.8%), about a third (n = 47; 34%) received a referral to PC support. However, less than a fifth of those without a lung cancer co-diagnosis (n = 16,934) were offered PC (n = 3268; 19.3%).</p><p class="pb-2"></p><p class="pb-2">Overall, during the study period, the proportion of patients with IPF and a PC referral increased from 2.9% in 2010 to 7.5% in 2019. Throughout the study period, women lagged behind men for PR and PC referrals. Therefore, in the fully-adjusted analysis, female sex and Black ethnicity were most strongly associated with non-referral, while older age and co-existing lung cancer, dementia, and cardiovascular comorbidities remained associated with PC referral.</p><p class="pb-2"></p><p class="pb-2">Before the end of the study period, just under half of the population died (n = 7918), 2658 (33.6%) of whom received a referral to PC services. The median time lapse between PC referral and death was 73 days (IQR, 20-229 days). About 70% were referred within 6 months of their death, while only 15% had a referral more than a year before they died. Additionally, patients who also had a COPD diagnosis (n = 515) were more likely to receive an “early” PC referral, meaning at least a year pre-death (relative risk ratio [RRR], 1,69; 95% CI, 1.27-2.26).</p><p class="pb-2"></p><p class="pb-2">Lastly, they acknowledged their limitations, including their inability to reliably identify referrals to PR and PC services in routinely collected primary care data; this is because they relied on the quality of patient consultation coding by GPs and practice staff. Despite their limitations, the researchers used their findings to suggest areas for future action.</p><p class="pb-2"></p><p class="pb-2">“While for this patient population, the benefits of PR and early referral to PC services are increasingly being recognized and embodied in current guidelines, it is evident that there needs to be substantial investment in service provision if the currently unmet demand for comprehensive and patient-centered PR and PC services is to be met,” the authors concluded.</p><p class="pb-2"></p><p class="pb-2"><strong>References</strong></p><ol class="my-2"><li class="list-decimal ml-8">Morgan AD, Khan H, George PM, Quint JK. Referral to pulmonary rehabilitation and palliative care services in people with idiopathic pulmonary fibrosis in England, 2010-2019. <em>NPJ Prim Care Respir Med</em>. 2024;34(1):27. doi:10.1038/s41533-024-00387-6</li><li class="list-decimal ml-8">Strongman H, Kausar I, Maher TM. Incidence, Prevalence, and survival of patients with idiopathic pulmonary fibrosis in the UK. <em>Adv Ther.</em> 2018;35(5):724-736. doi:10.1007/s12325-018-0693-1</li><li class="list-decimal ml-8">Gomes-Neto M, Silva CM, Ezequiel D, Conceição CS, Saquetto M, Machado AS. Impact of pulmonary rehabilitation on exercise tolerance and quality of life in patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis. <em>J Cardiopulm Rehabil Prev</em>. 2018;38(5):273-278. doi:10.1097/HCR.0000000000000273</li><li class="list-decimal ml-8">Oliveira A, Fabbri G, Gille T, et al. Holistic management of patients with progressive pulmonary fibrosis. <em>Breathe (Sheff)</em>. 2023;19(3):230101. doi:10.1183/20734735.0101-2023</li><li class="list-decimal ml-8">Wolf A, Dedman D, Campbell J, et al. Data resource profile: Clinical Practice Research Datalink (CPRD) Aurum. <em>Int J Epidemiol.</em> 2019;48(6):1740-1740g. doi:10.1093/ije/dyz034</li></ol></div></div><div class="flex items-center lg:w-3/4 mb-4 pb-12"></div><div class="jsx-19ede9f0a5a45918 py-4 relative bg-primary md:px-8 -ml-6 xs:ml-0 w-screen xs:w-auto"><div class="jsx-19ede9f0a5a45918 px-4 sm:px-0"><div class="flex justify-between items-center py-1 space-x-4 border-0 select-none sm:border-b border-secondary"><div class="text-3xl text-white text-lg sm:text-3xl">Related Videos</div></div></div><div style="scroll-snap-type:none" class="jsx-19ede9f0a5a45918 flex items-start overflow-x-auto space-x-4 py-4 relative mx-auto w-full pl-4"><a id="" class="w-[200px] h-fit space-y-3 flex-none select-none no-underline" style="scroll-snap-align:center;text-decoration:none" href="/view/navigating-healthcare-access-and-decision-making"><div class="w-full shadow-md shadow-gray-800 overflow-hidden relative bg-white aspect-video"><span 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overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/venetoclax-may-be-an-option-for-children-with-r-r-aml-mds?utm_source=www.ajmc.com&utm_medium=relatedContent"><img 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Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/venetoclax-may-be-an-option-for-children-with-r-r-aml-mds?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The single-center report showed the therapy had a favorable safety profile and manageable side effects in children with relapsed or refractory (R/R) acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS). </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a1728e6a06fccde8af20d2308f860344f9776b8f-800x400.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent">Frameworks for Advancing Health Equity: Wellness Way</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/facility-type-influences-antifibrotic-treatment-rates-in-patients-with-ipf?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/f1dd6b59e85295091f77dfc0c25fdeb8a9856a93-4592x3448.jpg?fit=crop&auto=format" alt="Exterior of a hospital | Image Credit: Spiroview Inc. - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/facility-type-influences-antifibrotic-treatment-rates-in-patients-with-ipf?utm_source=www.ajmc.com&utm_medium=relatedContent">Facility Type Influences Antifibrotic Treatment Rates in Patients With IPF</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/facility-type-influences-antifibrotic-treatment-rates-in-patients-with-ipf?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A study in Japan found that antifibrotic treatment rates for patients with idiopathic pulmonary fibrosis (IPF) varied by medical facility, with higher treatment rates observed in referral hospitals than in general hospitals or clinics.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4d74ae04b0508977864936ec08f2aaa199758e5c-1000x563.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 29th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent">Breaking the Cycle: The Importance of Early Intervention in Hidradenitis Suppurativa</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/durvalumab-underutilization-highlights-gaps-in-nsclc-treatment-strategies?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/20805afe527369d997c10f03a2d5ac2e3a49f2a3-1200x738.jpg?fit=crop&auto=format" alt="Lungcancertreatment | Image Credit: © Vitalii Vodolazskyi-stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/durvalumab-underutilization-highlights-gaps-in-nsclc-treatment-strategies?utm_source=www.ajmc.com&utm_medium=relatedContent">Durvalumab Underutilization Highlights Gaps in NSCLC Treatment Strategies</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/durvalumab-underutilization-highlights-gaps-in-nsclc-treatment-strategies?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Accompanying these findings is a call for refined treatment strategies that have potential to better outcomes among patients who have unresectable stage III non–small cell lung cancer (NSCLC).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/7928afa87272891a1211f02ab685217dc119fc12-5694x3800.jpg?fit=crop&auto=format" alt="Welcome to Vermont road sign | Image credit: rabbit75_fot – stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent">How Did Vermont Get the Best Maternal Health Score in the US?</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/hayden-e-klein">Hayden E. Klein</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">State-level maternal health scores varied greatly in the 2024 March of Dimes report card, with Vermont getting the only A grade on preterm birth rates.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="relative hidden sm:block"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/venetoclax-may-be-an-option-for-children-with-r-r-aml-mds?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/75f5ad09048956408787303005237932f9707c3c-5433x2890.jpg?fit=crop&auto=format" alt="MDS wooden blocks held by hand in glove | Image Credit: © Sviatlana - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/venetoclax-may-be-an-option-for-children-with-r-r-aml-mds?utm_source=www.ajmc.com&utm_medium=relatedContent">Venetoclax May Be an Option for Children With R/R AML, MDS </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/venetoclax-may-be-an-option-for-children-with-r-r-aml-mds?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The single-center report showed the therapy had a favorable safety profile and manageable side effects in children with relapsed or refractory (R/R) acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS). </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a1728e6a06fccde8af20d2308f860344f9776b8f-800x400.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent">Frameworks for Advancing Health Equity: Wellness Way</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/facility-type-influences-antifibrotic-treatment-rates-in-patients-with-ipf?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/f1dd6b59e85295091f77dfc0c25fdeb8a9856a93-4592x3448.jpg?fit=crop&auto=format" alt="Exterior of a hospital | Image Credit: Spiroview Inc. - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/facility-type-influences-antifibrotic-treatment-rates-in-patients-with-ipf?utm_source=www.ajmc.com&utm_medium=relatedContent">Facility Type Influences Antifibrotic Treatment Rates in Patients With IPF</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/facility-type-influences-antifibrotic-treatment-rates-in-patients-with-ipf?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A study in Japan found that antifibrotic treatment rates for patients with idiopathic pulmonary fibrosis (IPF) varied by medical facility, with higher treatment rates observed in referral hospitals than in general hospitals or clinics.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4d74ae04b0508977864936ec08f2aaa199758e5c-1000x563.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 29th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent">Breaking the Cycle: The Importance of Early Intervention in Hidradenitis Suppurativa</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/durvalumab-underutilization-highlights-gaps-in-nsclc-treatment-strategies?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/20805afe527369d997c10f03a2d5ac2e3a49f2a3-1200x738.jpg?fit=crop&auto=format" alt="Lungcancertreatment | Image Credit: © Vitalii Vodolazskyi-stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/durvalumab-underutilization-highlights-gaps-in-nsclc-treatment-strategies?utm_source=www.ajmc.com&utm_medium=relatedContent">Durvalumab Underutilization Highlights Gaps in NSCLC Treatment Strategies</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/durvalumab-underutilization-highlights-gaps-in-nsclc-treatment-strategies?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Accompanying these findings is a call for refined treatment strategies that have potential to better outcomes among patients who have unresectable stage III non–small cell lung cancer (NSCLC).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/7928afa87272891a1211f02ab685217dc119fc12-5694x3800.jpg?fit=crop&auto=format" alt="Welcome to Vermont road sign | Image credit: rabbit75_fot – stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent">How Did Vermont Get the Best Maternal Health Score in the US?</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/hayden-e-klein">Hayden E. Klein</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">State-level maternal health scores varied greatly in the 2024 March of Dimes report card, with Vermont getting the only A grade on preterm birth rates.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"Low Pulmonary Rehabilitation, Palliative Care Referrals for Patients With IPF Persist","datePublished":"2024-10-30T16:21:32.927Z","dateModified":"2024-10-30T17:03:35Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/ajmc/8803ff6f9490c9e1e62494b683ed2e8b961e7610-5500x3667.jpg?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.ajmc.com/view/low-pulmonary-rehabilitation-palliative-care-referrals-for-patients-with-ipf-persist"},"publisher":{"@type":"Organization","name":"AJMC","logo":{"@type":"ImageObject","url":"https://www.ajmc.com/ajmc_logo_inverted.png"}},"keywords":"IPF,pulmonary rehabilitation,palliative care,PR,PC,idiopathic pulmonary fibrosis","articleBody":"Despite improvements over the past decade, referrals to pulmonary rehabilitation (PR) programs and palliative care (PC) services among patients with idiopathic pulmonary fibrosis (IPF) in England remained low in 2019, according to a study published in NPJ Primary Care Respiratory Medicine.1\n\n\n\nTypically, once IPF is diagnosed, the prognosis is poor, with an average survival time of just 3 to 5 years among those in the United Kingdom (UK) who did not receive treatment.2 However, increasing research supports a holistic approach to managing those diagnosed with IPF, with PR and PC considered important components of such an approach.1\n\n\n\nOriginally, PR was created to support patients with chronic obstructive pulmonary disease (COPD), but, in recent years, evidence has emerged of its benefits among those with IPF.3 Similarly, several studies have demonstrated that access to integrated PC services improves the quality of life of patients with IPF.1\n\n\n\nConversely, the researchers noted that PR and PC service provision is poor among those with IPF, with referral rates typically much lower than those with other respiratory conditions, like COPD or lung cancer. National registry data from several countries, including the US, Germany, and Spain, demonstrated that less than 20% of those diagnosed with IPF are offered a PC referral and less than 10% attend PR.4\n\n\n\nTo add to this data, the researchers conducted a study to examine UK trends in referrals to PR and PC for patients with IPF.1 They also investigated demographic and patient factors linked to referrals. \n\n\n\nThe study used the Clinical Practice Research Datalink (CPRD) Aurum database, a curated set of patient-level electronic health records from 1345 participating UK general practitioner (GP) practices5; it is representative of the UK population in terms of age, ethnicity, and sex.\n\n\n\nEligible patients were registered at linkage-eligible CPRD Aurum GP practices and diagnosed with IPF on or after the start of the study period (January 1, 2010) but before the end of the study period (December 31, 2019).1 They also needed to be at least 40 years old at the time of their IPF diagnosis, meet CPRD-defined data quality criteria, and have at least 1 year of continuous registration with their current GP before their IPF diagnosis.\n\n\n\nFor each patient, follow-up began on the latest of the following dates: the start of the study period, the date of registration with their GP practice, the date of their 40th birthday, or the date of IPF diagnosis. Then, follow-up concluded on the earliest of the following dates: the end of the study, the date of death, or the last day of either practice registration or data collection.\n\n\n\nThe researchers considered patients to have been referred to PR or PC if their primary care record included evidence that they had been considered and/or offered a referral to PR or PC after their IPF diagnosis and within their follow-up period. Additionally, the selected risk factors comprised demographic characteristics, smoking status, lifestyle characteristics, and the presence of selected comorbid diseases; these included COPD, lung cancer, and asthma.\n\n\n\nThe study population consisted of 17,071 patients with IPF, most of whom were male (62.6%), White (92.3%), and had a history of smoking (88.5%). The median age at diagnosis was 76.7 years, and the most common comorbidities were ischemic heart disease (IHD; 27.2%), depression/anxiety (25.7%), and diabetes (23.7%).\n\n\n\nDuring follow-up, 2042 patients (12.0%) were referred to PR. More men than women were referred to PR (13.0% vs 10.2%), and nearly half of all referrals occurred in those between the ages of 70 and 79 (43.6%). Also, 22.3% of those referred were current smokers. Compared with the non-referral group (non-PR group), comorbidities like COPD, asthma, and depression/anxiety, were more common among the referral group (PR group). For example, 40.9% of the PR group vs 12.9% of the non-PR group also had COPD.\n\n\n\nThrough temporal analyses, the researchers discovered that, in 2010, only 1.2% of patients were offered PR (15 of 1246 patients). By 2019, this proportion rose to 6.5% (574 of 8811 patients). Although referral proportions were higher in those who received a previous diagnosis of COPD, they observed a steady referral proportion increase over time, even among those without a COPD diagnosis.\n\n\n\nAfter adjusting for potential confounders, smoking history, a prior COPD diagnosis, and male sex were strongly positively associated with PR referral. Conversely, potential contributory factors to non-referral include older age (over 80 years old), co-existing dementia, and the presence of IHD.\n\n\n\nOn the other hand, 19.4% (2159 men; 1156 women) of the study population were referred to PC support services; nearly 80% of referrals occurred in those over 70 years old. Lung cancer and pre-existing cardiovascular conditions were among the comorbidities more prevalent among the PC group. Of those diagnosed with lung cancer (n = 137; 0.8%), about a third (n = 47; 34%) received a referral to PC support. However, less than a fifth of those without a lung cancer co-diagnosis (n = 16,934) were offered PC (n = 3268; 19.3%).\n\n\n\nOverall, during the study period, the proportion of patients with IPF and a PC referral increased from 2.9% in 2010 to 7.5% in 2019. Throughout the study period, women lagged behind men for PR and PC referrals. Therefore, in the fully-adjusted analysis, female sex and Black ethnicity were most strongly associated with non-referral, while older age and co-existing lung cancer, dementia, and cardiovascular comorbidities remained associated with PC referral.\n\n\n\nBefore the end of the study period, just under half of the population died (n = 7918), 2658 (33.6%) of whom received a referral to PC services. The median time lapse between PC referral and death was 73 days (IQR, 20-229 days). About 70% were referred within 6 months of their death, while only 15% had a referral more than a year before they died. Additionally, patients who also had a COPD diagnosis (n = 515) were more likely to receive an “early” PC referral, meaning at least a year pre-death (relative risk ratio [RRR], 1,69; 95% CI, 1.27-2.26).\n\n\n\nLastly, they acknowledged their limitations, including their inability to reliably identify referrals to PR and PC services in routinely collected primary care data; this is because they relied on the quality of patient consultation coding by GPs and practice staff. Despite their limitations, the researchers used their findings to suggest areas for future action.\n\n\n\n“While for this patient population, the benefits of PR and early referral to PC services are increasingly being recognized and embodied in current guidelines, it is evident that there needs to be substantial investment in service provision if the currently unmet demand for comprehensive and patient-centered PR and PC services is to be met,” the authors concluded.\n\n\n\nReferences\n\nMorgan AD, Khan H, George PM, Quint JK. Referral to pulmonary rehabilitation and palliative care services in people with idiopathic pulmonary fibrosis in England, 2010-2019. NPJ Prim Care Respir Med. 2024;34(1):27. doi:10.1038/s41533-024-00387-6\n\nStrongman H, Kausar I, Maher TM. Incidence, Prevalence, and survival of patients with idiopathic pulmonary fibrosis in the UK. Adv Ther. 2018;35(5):724-736. doi:10.1007/s12325-018-0693-1\n\nGomes-Neto M, Silva CM, Ezequiel D, Conceição CS, Saquetto M, Machado AS. Impact of pulmonary rehabilitation on exercise tolerance and quality of life in patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis. J Cardiopulm Rehabil Prev. 2018;38(5):273-278. doi:10.1097/HCR.0000000000000273\n\nOliveira A, Fabbri G, Gille T, et al. Holistic management of patients with progressive pulmonary fibrosis. Breathe (Sheff). 2023;19(3):230101. doi:10.1183/20734735.0101-2023\n\nWolf A, Dedman D, Campbell J, et al. Data resource profile: Clinical Practice Research Datalink (CPRD) Aurum. Int J Epidemiol. 2019;48(6):1740-1740g. doi:10.1093/ije/dyz034","description":"Despite proven benefits, referrals to pulmonary rehabilitation and palliative care for patients with idiopathic pulmonary fibrosis (IPF) in England remain significantly lower than for other respiratory conditions.","author":[{"@type":"Person","name":"Brooke McCormick"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NK5KQXS" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class=" mx-auto flex"><div class="bg-[#00598D] xl:w-[70%] w-[70%] py-12 pl-auto"><div class="xxl:w-[75%] w-[90%] 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Then, follow-up concluded on the earliest of the following dates: the end of the study, the date of death, or the last day of either practice registration or data collection.","_key":"96ad184e1b110"}],"_type":"block","style":"normal","_key":"4255ab3b502b","upload_doc":null,"uploadAudio":null,"medias":null},{"upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"text":"","_key":"e3f1c7d371940","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2003f9c518c0"},{"medias":null,"children":[{"text":"The researchers considered patients to have been referred to PR or PC if their primary care record included evidence that they had been considered and/or offered a referral to PR or PC after their IPF diagnosis and within their follow-up period. Additionally, the selected risk factors comprised demographic characteristics, smoking status, lifestyle characteristics, and the presence of selected comorbid diseases; these included COPD, lung cancer, and asthma.","_key":"1c504a8de9230","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"114ba85bef7a","markDefs":[],"upload_doc":null,"uploadAudio":null},{"_key":"64e0dec20ece","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"","_key":"900a652b0bf70"}],"_type":"block","style":"normal"},{"children":[{"text":"The study population consisted of 17,071 patients with IPF, most of whom were male (62.6%), White (92.3%), and had a history of smoking (88.5%). The median age at diagnosis was 76.7 years, and the most common comorbidities were ischemic heart disease (IHD; 27.2%), depression/anxiety (25.7%), and diabetes (23.7%).","_key":"1ebea74848080","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"c7b6a9929114","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null},{"medias":null,"style":"normal","_key":"d26990c8a09e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"080d1bdbfede0"}],"_type":"block","upload_doc":null,"uploadAudio":null},{"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"During follow-up, 2042 patients (12.0%) were referred to PR. More men than women were referred to PR (13.0% vs 10.2%), and nearly half of all referrals occurred in those between the ages of 70 and 79 (43.6%). Also, 22.3% of those referred were current smokers. Compared with the non-referral group (non-PR group), comorbidities like COPD, asthma, and depression/anxiety, were more common among the referral group (PR group). For example, 40.9% of the PR group vs 12.9% of the non-PR group also had COPD.","_key":"b1b64fd7cacb0"}],"_type":"block","style":"normal","_key":"9ee7a79fd831","upload_doc":null},{"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"9ce606579718"}],"_type":"block","style":"normal","_key":"2b2a4c0e4c8b","upload_doc":null,"uploadAudio":null},{"style":"normal","_key":"7ff563510fd7","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"marks":[],"text":"Through temporal analyses, the researchers discovered that, in 2010, only 1.2% of patients were offered PR (15 of 1246 patients). By 2019, this proportion rose to 6.5% (574 of 8811 patients). Although referral proportions were higher in those who received a previous diagnosis of COPD, they observed a steady referral proportion increase over time, even among those without a COPD diagnosis.","_key":"27d7af5a547e0","_type":"span"}],"_type":"block"},{"style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"2853cca2f902","markDefs":[],"children":[{"_key":"24cca910031c0","_type":"span","marks":[],"text":""}],"_type":"block"},{"children":[{"text":"After adjusting for potential confounders, smoking history, a prior COPD diagnosis, and male sex were strongly positively associated with PR referral. Conversely, potential contributory factors to non-referral include older age (over 80 years old), co-existing dementia, and the presence of IHD.","_key":"ac2b3a055d5a0","_type":"span","marks":[]}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block","style":"normal","_key":"c6db08fa1bb8","markDefs":[]},{"_key":"cd4006ff4445","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_key":"d115cf2afb1c0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"0a837cc23ba2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"On the other hand, 19.4% (2159 men; 1156 women) of the study population were referred to PC support services; nearly 80% of referrals occurred in those over 70 years old. Lung cancer and pre-existing cardiovascular conditions were among the comorbidities more prevalent among the PC group. Of those diagnosed with lung cancer (n = 137; 0.8%), about a third (n = 47; 34%) received a referral to PC support. However, less than a fifth of those without a lung cancer co-diagnosis (n = 16,934) were offered PC (n = 3268; 19.3%).","_key":"f59ad79ba8140"}],"_type":"block"},{"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"","_key":"c5dc4e76ad320"}],"_type":"block","style":"normal","_key":"26dfbaabd34a","markDefs":[],"upload_doc":null},{"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"marks":[],"text":"Overall, during the study period, the proportion of patients with IPF and a PC referral increased from 2.9% in 2010 to 7.5% in 2019. Throughout the study period, women lagged behind men for PR and PC referrals. 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About 70% were referred within 6 months of their death, while only 15% had a referral more than a year before they died. Additionally, patients who also had a COPD diagnosis (n = 515) were more likely to receive an “early” PC referral, meaning at least a year pre-death (relative risk ratio [RRR], 1,69; 95% CI, 1.27-2.26).","_key":"93d2fb79ccfa0"}],"_type":"block","style":"normal","_key":"565ad4bfa657"},{"_type":"block","style":"normal","_key":"2dba85259496","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"bc30d788003d0"}],"upload_doc":null,"uploadAudio":null,"medias":null},{"children":[{"_type":"span","marks":[],"text":"Lastly, they acknowledged their limitations, including their inability to reliably identify referrals to PR and PC services in routinely collected primary care data; this is because they relied on the quality of patient consultation coding by GPs and practice staff. 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The study analyzed data from the Clinical Practice Research Datalink (CPRD) Aurum database, revealing that only 12% were referred to PR and 19.4% to PC. Factors influencing referrals included smoking history, COPD diagnosis, and male sex. Non-referral was linked to older age, dementia, and ischemic heart disease. 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The report was ","_key":"a1ac0c58f3930","_type":"span"},{"_key":"a1ac0c58f3931","_type":"span","marks":["738e3e3a1fff"],"text":"published in the "},{"_type":"span","marks":["f1d5a281df7f","em"],"text":"British Journal of Haemaotology","_key":"a1ac0c58f3932"},{"_key":"a1ac0c58f3933","_type":"span","marks":[],"text":"."},{"_type":"span","marks":["superscript"],"text":"1","_key":"1dfc28099771"}]},{"children":[{"marks":[],"text":"There is no universal standard of care in R/R AML, noted corresponding author Sophie Cousson, MD, of the Robert Debré Academic Hospital, in Paris, and colleagues. The BCL-2 inhibitor venetoclax has become a first-line option in combination with hypomethylating agents (HMAs) or low-dose cytarabine in certain adults with newly diagnosed AML, gaining FDA approval in 2018.","_key":"57cf581bdb5d0","_type":"span"}],"_type":"block","style":"normal","_key":"86dab1b1cf4e","markDefs":[]},{"disableLightBox":true,"widthP":30,"_key":"56f364ca54a5","disableTextWrap":false,"alt":"MDS wooden blocks held by hand in glove | Image Credit: © Sviatlana - stock.adobe.com","asset":{"_ref":"image-75f5ad09048956408787303005237932f9707c3c-5433x2890-jpg","_type":"reference"},"_type":"figure","imgcaption":[{"style":"normal","_key":"c572e73ad2c3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"More research is needed to understand molecular determinants of response to venetoclax-based regimens. | Image Credit: © Sviatlana - stock.adobe.com","_key":"f901064811f90"}],"_type":"block"}],"alignment":"right"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“This authorization has sparked interest in exploring venetoclax-based regimens for pediatric R/R leukemia,” Cousson and colleagues wrote.","_key":"6e968680d42f0"}],"_type":"block","style":"normal","_key":"6349b0d21481"},{"markDefs":[{"_key":"c1e73108c11d","nofollow":true,"blank":true,"_type":"link","href":"https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30060-7/fulltext"}],"children":[{"_type":"span","marks":[],"text":"They noted that a ","_key":"2b3d498342980"},{"_type":"span","marks":["c1e73108c11d"],"text":"2020 report","_key":"2b3d498342981"},{"_type":"span","marks":[],"text":" found venetoclax plus chemotherapy led to an overall response rate (ORR) of 80% (95% CI, 56%-94%) and a complete response (CR) rate of 70% (95% CI, 46%-88%) in pediatric patients with heavily relapsed and refractory AML treated with the recommended phase 2 dose of venetoclax of 360 mg/m","_key":"2b3d498342982"},{"marks":["superscript"],"text":"2","_key":"a52a59124b49","_type":"span"},{"_type":"span","marks":[],"text":".","_key":"8972e5760b0e"},{"_type":"span","marks":["superscript"],"text":"2","_key":"57da985937ce"}],"_type":"block","style":"normal","_key":"4ab476724e6f"},{"style":"normal","_key":"134d54202d28","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Subsequent research into pediatric use of venetoclax has shown that the therapy works best when combined with other therapeutic agents, has a favorable safety profile, and could be used as a bridge to allogeneic hematopoietic stem cell transplantation (allo-HSCT), Cousson and colleagues said.","_key":"e8685b012ae00"},{"_type":"span","marks":["superscript"],"text":"1","_key":"1c63a8f814ef"}],"_type":"block"},{"markDefs":[],"children":[{"text":"In the new report, the investigators analyzed the cases of 12 patients, ranging in age from 2 to 12 years, who were given venetoclax-based regimens for R/R myeloid malignancies. Eight of the patients had previously experienced relapse, 5 patients were given venetoclax after allo-HSCT, and 3 patients had refractory AML, the authors said. One patient had MDS-related AML (MDS-AML), and the remainder had R/R AML.","_key":"0cc685bed3420","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"499084483a59"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The patients received either venetoclax plus HMAs (5 patients) or chemotherapy (5 patients) or venetoclax alone (2 patients). At a median follow-up of 11 months, the investigators said the ORR for the cohort was 41.6% and 33% of patients achieved CR.","_key":"4ca0bd0b76b30"}],"_type":"block","style":"normal","_key":"bac6a2e353d5"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The CR rate was best (60%) in patients who received venetoclax plus cytotoxic agents. In those receiving venetoclax plus HMAs, just 1 patient achieved a complete response with incomplete recovery. Neither of the 2 patients on venetoclax monotherapy responded.","_key":"098b783de5ab0"}],"_type":"block","style":"normal","_key":"1b15ab29139a"},{"_key":"2bcb5a1bc0ba","markDefs":[],"children":[{"_key":"d5e6fbff6b0d0","_type":"span","marks":[],"text":"The 1-year overall survival rate was 50% (95% CI, 28%-88%), and 1-year event-free survival rate was 25% (95% CI, 9.4%-67%)."}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"By the end of follow-up, 11 patients had died. Most of the patients died as a result of progression or relapse (10 patients), but 1 patient died due to an infection associated with transplantation.","_key":"356bcb4614cc0"}],"_type":"block","style":"normal","_key":"fbbce19c3922"},{"_type":"block","style":"normal","_key":"b2dca6780a6e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Cousson and colleagues said the single-center nature of the study limits the conclusions that can be drawn from it, but they said the data still provide valuable insights. 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were conditionally ","_key":"f9893d4efac20"},{"_type":"span","marks":["e101f6e6119b"],"text":"recommended","_key":"9efc2755f6de"},{"_type":"span","marks":[],"text":" for patients with IPF in 2015 clinical practice guidelines.","_key":"5c5665a87240"},{"_type":"span","marks":["superscript"],"text":"2","_key":"9f30dbcdad11"},{"_key":"2b460d32f94f","_type":"span","marks":[],"text":" Phase 3 trials showed that pirfenidone reduced disease progression in patients with IPF compared with placebo."},{"text":"1","_key":"c83540f59a89","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" Similarly, other phase 3 trials demonstrated that nintedanib slows the decline in forced vital capacity (FVC) and decreases the risk of acute exacerbation in patients with IPF.","_key":"d79f0f4ba038"}],"_type":"block","style":"normal","_key":"0f32077b8479"},{"_type":"block","style":"normal","_key":"556622a68323","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c647fe9caecb0"}]},{"style":"normal","_key":"185ec7c45c7d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Despite these benefits, an online survey of respiratory physicians across Europe found that 54% of those with IPF were not receiving antifibrotic therapy. The researchers noted that many untreated patients had mild IPF, indicating a lack of proactive treatment.","_key":"1786ff5389d00"}],"_type":"block"},{"_type":"block","style":"normal","_key":"bd544b033879","markDefs":[],"children":[{"_key":"ba73852589c10","_type":"span","marks":[],"text":""}]},{"markDefs":[],"children":[{"text":"Conversely, some cases present challenges for initiating antifibrotic therapy, and poor PS can hinder treatment continuation; starting therapy in patients with preserved PS is preferable. Building on past research, the researchers surveyed general practitioners and respiratory physicians in Japan to determine the proportion of untreated patients with IPF and factors associated with nonintervention.","_key":"5579653999780","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"66c63c57ca1a"},{"alt":"Exterior of a hospital | Image Credit: Spiroview Inc. - stock.adobe.com","widthP":40,"disableTextWrap":false,"imgcaption":[{"_key":"308532b7e3b2","markDefs":[],"children":[{"text":"Antifibrotic treatment rates for patients with idiopathic pulmonary fibrosis (IPF) varied by medical facility, with higher treatment rates observed in referral hospitals than in general hospitals or clinics. | Image Credit: Spiroview Inc. - stock.adobe.com","_key":"2b83b0b08ece","_type":"span","marks":[]}],"_type":"block","style":"normal"}],"_key":"2939b480fd65","asset":{"_type":"reference","_ref":"image-f1dd6b59e85295091f77dfc0c25fdeb8a9856a93-4592x3448-jpg"},"alignment":"right","disableLightBox":true,"_type":"figure"},{"markDefs":[],"children":[{"text":"The study was conducted at 23 medical facilities (9 clinics, 12 general hospitals, 1 university hospital, and 1 specialized respiratory hospital) in Yamaguchi, Japan, from December 2019 to October 2020. The researchers included patients diagnosed with IPF at the study facility.","_key":"92476cdfcdbf0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"218de00e81b4"},{"_key":"e0ebc73c01cc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5c74ca26fc0a0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"Both physicians and patients conducted the surveys. Patients completed a 3-item questionnaire on PS, cough symptom severity, and the modified Medical Research Council (mMRC) scale. In contrast, physicians recorded patients' demographic data, clinical characteristics, and IPF diagnoses. They also recorded clinical examination data, treatment details, when treatment started, and why; for those who did not receive treatment, the physicians recorded the reasons why.","_key":"32a68fa996790","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"7e25fab5b342"},{"_key":"5df46ffb0cc2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8a631a22d4fb0"}],"_type":"block","style":"normal"},{"_key":"24cdddf66e01","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Physicians in the specialized respiratory and university hospitals also asked about the time from diagnosis at other facilities to referral, pulmonary function test (PFT) results, and Krebs von den Lungen 6 (KL-6) and surfactant protein D (Sp-D) values at the initial visit. ","_key":"777ac23244e30"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"7c39b5f03be4","_type":"span"}],"_type":"block","style":"normal","_key":"8d63c4c5ab36"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The researchers performed a principal component analysis (PCA) using 15 clinical variables, including age, sex, medical facility, body mass index (BMI), specialized tests, and symptom severity. In the PCA plots, the researchers evaluated the distribution of clinical variables vs antifibrotic treatment.","_key":"2ecfffb092c6"}],"_type":"block","style":"normal","_key":"ed023c3455f7"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e78245645f0a0"}],"_type":"block","style":"normal","_key":"1b5aff0d650c"},{"_type":"block","style":"normal","_key":"5f9e9f8aea0d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The researchers enrolled 518 patients with interstitial lung disease (ILD) in the study, 207 of whom were diagnosed with IPF. Among these 207 patients, 168 had a good PS, or a PS of 2 or less, which could indicate their treatment eligibility. Their mean (SD) age was 76.5 (8.2), and most (72.6%) were male. Also, 125 (74%) received treatment at a general hospital, 29 (17%) at either a specialized respiratory or a university hospital, and 14 (8%) at a clinic.","_key":"72be55df72210"}]},{"_key":"8a0422349fc3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d2dda4277fa10"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Of those with IPF, 39 (22.6%) received an antifibrotic drug. The PCA determined that the rate of antifibrotic treatment was significantly higher in referral hospitals than in clinics or general hospitals. Based on physicians’ questionnaires, most did not prescribe antifibrotic drugs due to mild symptoms, imaging findings, or oxygenation, with no differences between facilities. ","_key":"f402874016ac0"}],"_type":"block","style":"normal","_key":"857ca7efc518"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c5ae02e7402f"}],"_type":"block","style":"normal","_key":"9a3542063244"},{"_type":"block","style":"normal","_key":"558459c819ac","markDefs":[],"children":[{"_type":"span","marks":[],"text":"However, for those who received antifibrotic drugs, the time from diagnosis to treatment in referral hospitals (16 cases) and general hospitals (20 cases) was a mean (SD) of 24.5 (35.7) and 35.5 (40.0) months, respectively; there were no significant differences.","_key":"c1b9ce7e0a5d"}]},{"children":[{"_key":"31a7e09702620","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"405c9cc5899e","markDefs":[]},{"children":[{"_key":"3bea81611d950","_type":"span","marks":[],"text":"The researchers found that treatment rates were significantly higher among patients with poor PS, higher mMRC scores, and long-term oxygen therapy (LTOT) users ("},{"marks":["em"],"text":"P ","_key":"3bea81611d951","_type":"span"},{"_type":"span","marks":[],"text":"\u003c .0001). Therefore, symptom severity is a relevant factor for therapeutic intervention decisions in general hospitals. Conversely, treatment rates in referral hospitals were not associated with PS, mMRC score, or LTOT use; symptom severity is not considered when deciding on therapeutic intervention in this setting.","_key":"3bea81611d952"}],"_type":"block","style":"normal","_key":"6d62900c1858","markDefs":[]},{"_key":"c6d313d6b853","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2143012e56060"}],"_type":"block","style":"normal"},{"style":"normal","_key":"0fcce14fd947","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The researchers acknowledged their limitations, one being that they conducted their study in a rural part of Japan rather than an urban area. Therefore, it cannot be considered an overall assessment of the country. Similarly, because it only analyzed patients within Japan, the findings may not be generalizable to other populations. Despite this, the researchers expressed confidence in their findings.","_key":"733fa6ec90cb0"}],"_type":"block"},{"style":"normal","_key":"c123d1713c4c","markDefs":[],"children":[{"marks":[],"text":"","_key":"ec99bb31c7f20","_type":"span"}],"_type":"block"},{"_type":"block","style":"normal","_key":"673ca5ee1f79","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“Our findings indicate that further awareness of the indications for antifibrotic therapy in mild cases of IPF and collaboration between general and specialized hospitals are required,” the authors concluded.","_key":"6782f7edc4e90"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0dfe505ed68c0"}],"_type":"block","style":"normal","_key":"6912c26a1eb1"},{"children":[{"text":"References","_key":"de858caaf4a60","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"7e5e3dae0a29","markDefs":[]},{"_type":"block","style":"normal","_key":"a3c3837dd0f9","listItem":"number","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Asami-Noyama M, Hamada K, Asai Y, et al. Factors associated with non-intervention of antifibrotic agents in IPF patients. ","_key":"0a33c3b7d7640"},{"_type":"span","marks":["em"],"text":"Respir Investig","_key":"0a33c3b7d7641"},{"_type":"span","marks":[],"text":". 2024;62(6):1124-1131. doi:10.1016/j.resinv.2024.09.008","_key":"0a33c3b7d7642"}],"level":1},{"style":"normal","_key":"b03312dca755","listItem":"number","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Raghu G, Rochwerg B, Zhang Y, et al. An official ATS/ERS/JRS/ALAT clinical practice guideline: treatment of idiopathic pulmonary fibrosis. An update of the 2011 clinical practice guideline. ","_key":"06eba3e3756d"},{"_type":"span","marks":["em"],"text":"Am J Respir Crit Care Med","_key":"c4d9c2f6ec1f"},{"_type":"span","marks":[],"text":". 2015;192(2):e3-e19. doi:10.1164/rccm.201506-1063ST","_key":"22676122d674"}],"level":1,"_type":"block"},{"style":"normal","_key":"61955594e8b9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e4798401fcfa0"}],"_type":"block"},{"_key":"38a62e35034c","markDefs":[],"children":[{"marks":[],"text":"","_key":"195093f8dbb70","_type":"span"}],"_type":"block","style":"normal"}],"documentGroupMapping":null,"gptTakeaways":"• Antifibrotic treatment rates for IPF differ significantly between referral hospitals and general hospitals or clinics, with higher rates in referral hospitals.\n\n• Many patients with mild IPF remain untreated, often due to mild symptoms, imaging findings, or oxygenation levels, regardless of the facility type.\n\n• Symptom severity influences therapeutic intervention decisions in general hospitals but not in referral hospitals, where treatment rates are not associated with PS, mMRC score, or LTOT use.\n\n• The study's rural setting and focus on a Japanese population limit its generalizability, highlighting the need for further research in diverse settings.","thumbnail":{"_type":"mainImage","alt":"Exterior of a hospital | Image Credit: Spiroview Inc. - stock.adobe.com","asset":{"_ref":"image-f1dd6b59e85295091f77dfc0c25fdeb8a9856a93-4592x3448-jpg","_type":"reference"}},"ExcludeFromPubMedXML":false,"_type":"article","factCheckAuthorMapping":null,"articleType":"News","seoTag":["IPF","antifibrotic drugs","idiopathic pulmonary fibrosis","Pirfenidone ","nintedanib"],"targeting":{"content_placement":["news","topic/clinical","compendium/ipf"],"document_url":["facility-type-influences-antifibrotic-treatment-rates-in-patients-with-ipf"],"document_group":null,"rootDocumentGroup":[],"issue_url":"","publication_url":""},"relatedArticles":[{"title":"Venetoclax May Be an Option for Children With R/R 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intervention is essential in treating hidradenitis suppurativa (HS) due to its progressive nature and potential for severe physical and psychological impact. 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For their retrospective observational analysis, they used data on newly diagnosed patients from The US Oncology Network’s electronic health record; their treatment window encompassed patients who received their diagnosis and initiated cCRT between November 1, 2017, and October 31, 2019, and who were followed through April 30, 2022. cCRT was defined as “radiotherapy received +/-14 days of receipt of the first dose of chemotherapy.”","_key":"af3af6bde8362","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"ae39d66391b5"},{"children":[{"_type":"span","marks":[],"text":"","_key":"e4a28394c1170"}],"_type":"block","style":"normal","_key":"eac751ebfd41","markDefs":[]},{"disableTextWrap":false,"_type":"figure","imgcaption":[{"_key":"97e4882ba2ed","markDefs":[],"children":[{"text":"The most recent US approval for durvalumab came in August, when it was approved for use in combination with chemotherapy for resectable early-stage disease. | Image Credit: © Vitalii Vodolazskyi-stock.adobe.com","_key":"2902075f001d0","_type":"span","marks":[]}],"_type":"block","style":"normal"}],"widthP":40,"_key":"d44448c3b780","disableLightBox":true,"alt":"Lungcancertreatment | Image Credit: © Vitalii Vodolazskyi-stock.adobe.com","alignment":"right","asset":{"_ref":"image-20805afe527369d997c10f03a2d5ac2e3a49f2a3-1200x738-jpg","_type":"reference"}},{"_key":"3e0d3a9bbcfe","markDefs":[],"children":[{"marks":[],"text":"Of the 540 patients included in this study, 61.5% (n = 262) received durvalumab following cCRT and 38.5% (n = 164) only received cCRT. Their median (IQR) age was 70.6 (63.7-76.3) years, less than half (44.6%) were female patients, most reported a White race (72.3%), the median body mass index was 25.4 (22.3-28.7) mg/m","_key":"da376202c85e0","_type":"span"},{"marks":["superscript"],"text":"2","_key":"a9b889930af2","_type":"span"},{"_type":"span","marks":[],"text":", 57.3% were former smokers, 52.8% had diagnosed nonsquamous histology, and 67.8% had an ECOG performance status of 0 to 1.","_key":"4b3813b52878"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1b7962b2e3df0"}],"_type":"block","style":"normal","_key":"329df61a629e"},{"children":[{"marks":[],"text":"With the index date being initiation of cCRT after confirmed diagnosis, the investigators saw that patients who received cCRT and durvalumab had the longest median follow-up after the index date and those who only received cCRT, the shortest: 30.4 (13.5-38.0) vs 6.0 (2.6-15.1) months. Carboplatin plus paclitaxel was the most common chemotherapy regimen across both patient groups (86.6%, cCRT and durvalumab; 90.9%, cCRT alone).","_key":"1d97c9cec9fb0","_type":"span"}],"_type":"block","style":"normal","_key":"801237205efb","markDefs":[]},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"0ec3a642d09a0","_type":"span"}],"_type":"block","style":"normal","_key":"ec9013b3ffa3"},{"style":"normal","_key":"0e8853a10621","markDefs":[],"children":[{"_type":"span","marks":[],"text":"However, more patients who received cCRT and durvalumab vs cCRT alone experienced disease progression (41.6% vs 31.3%). Among these patients, most in the former group next received an ICI in combination (37.1%) whereas those in the latter group most often received a chemotherapy combination (46.5%). The most common documented reasons for not receiving consolidation durvalumab were death (28.3%) or disease progression (22.2%), and for discontinuing durvalumab before completing all treatments, adverse events (35.8%) or disease progression (28.4%).","_key":"12e9ab3703c90"}],"_type":"block"},{"_type":"block","style":"normal","_key":"f90220751077","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1caca4dc6b920"}]},{"style":"normal","_key":"27fd570db851","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Among patients who received durvalumab after cCRT, the median real-world overall survival (rwOS) was 50.2 (95% CI, 41.4–not reached [NR]) months, and the 12-month survival rate, 83.6% (95% CI, 78.4%-87.6%). The corresponding totals for those who only received cCRT were 11.6 (95% CI, 6.5-15.9) months and 49.1% (95% CI, 40.4%-57.2%). In particular, among those who received consolidation durvalumab, their rwOS was 46.6 (95% CI, 38.3-NR) months and 12-month survival rate, 78.2% (95% CI, 72.5%-82.8%), after consolidation initiation.","_key":"9683623fb2ee0"}],"_type":"block"},{"style":"normal","_key":"f76f6925d095","markDefs":[],"children":[{"marks":[],"text":"","_key":"4060d14539700","_type":"span"}],"_type":"block"},{"_type":"block","style":"normal","_key":"61c7e0cf1447","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Throughout the study observation period, an overall 60.8% had disease progression or died; this was lower in those who received consolidation durvalumab after cCRT vs cCRT alone: 56.5% vs 67.7%. Median real-world progression-free survival (rwPFS) was 28.5 (95% CI, 23.3-36.4) and 6.3 (95% CI, 4.3-9.3) months, respectively, from the index date, and 12-month rwPFS probability, 72.2% (95% CI, 66.3%-77.2%) and 35.0% (95% CI, 27.1%-43.0%). From start of consolidation durvalumab, median rwPFS was 25.4 (95% CI, 20.7-32.7) months, and the 12-month PFS probability, 65.8% (95% CI, 59.7%-71.3%).","_key":"fbb47bec71d60"}]},{"style":"normal","_key":"53d27b252b97","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f9e5eed463c10"}],"_type":"block"},{"_key":"b93e854d8dd7","markDefs":[],"children":[{"_key":"1de91c8adb830","_type":"span","marks":[],"text":"Strengths of these findings are that the data on underutilization of durvalumab from death or disease progression and treatment discontinuation echo previous research, which the authors note “suggest the need for more effective induction therapy for patients with unresectable stage III NSCLC, to allow a greater number of these patients to have stable disease and continue consolidation treatment.” They also highlight gaps in treatment strategies for ICIs that serve to strengthen treatment adherence and outcomes."}],"_type":"block","style":"normal"},{"style":"normal","_key":"59be840443d2","markDefs":[],"children":[{"text":"","_key":"fe8129f8f6c60","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“While durvalumab addresses a critical need for patients with unresectable stage III NSCLC,” they concluded, “our study underscores the need for additional treatment strategies to address the limitations of consolidation treatment with ICI therapy and explore the best mode of application of ICI in this patient population.”","_key":"97199f3724390"}],"_type":"block","style":"normal","_key":"7c213209f3f7"},{"children":[{"_key":"9ecb527029880","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"bcb0a8346411","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"fddbb99b973c0"}],"_type":"block","style":"normal","_key":"e6dadd68dcbc"},{"_key":"5dc61260028e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"1. 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You can connect with Hayden on ","_key":"3c55bddd8456"},{"marks":["b0bea7fd1873"],"text":"LinkedIn","_key":"607fdc2dfcbb1","_type":"span"},{"marks":[],"text":".","_key":"607fdc2dfcbb2","_type":"span"}]}],"_updatedAt":"2024-05-20T19:26:45Z","firstName":"Hayden","lastName":"Klein"}],"ExcludeFromPubMedXML":false,"body":[{"markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.marchofdimes.org/peristats/reports/vermont/report-card","_key":"03e093aec7c2"}],"children":[{"_key":"75b7c20fac040","_type":"span","marks":[],"text":"Vermont emerged as a leader in maternal and infant health in the latest "},{"_type":"span","marks":["03e093aec7c2"],"text":"March of Dimes report card","_key":"75b7c20fac041"},{"_type":"span","marks":[],"text":", achieving the best scores—and the only A—in the country.","_key":"75b7c20fac042"},{"_type":"span","marks":["superscript"],"text":"1","_key":"cea17ad94dc7"}],"_type":"block","style":"normal","_key":"c38c1594ddd5"},{"_key":"f29f67736beb","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"10c5c7a7d8f30"}],"_type":"block","style":"normal"},{"style":"normal","_key":"11ab60873531","markDefs":[{"blank":true,"_type":"link","href":"https://www.ajmc.com/view/us-earns-another-low-grade-on-maternal-health","_key":"b23ab706a685"}],"children":[{"_type":"span","marks":[],"text":"The March of Dimes 2024 report card included all 50 states; Washington, DC; and Puerto Rico in the report and gave the country ","_key":"3fcc731bdb490"},{"_type":"span","marks":["b23ab706a685"],"text":"overall a D+","_key":"3fcc731bdb491"},{"_type":"span","marks":[],"text":" for its 2023 preterm birth rate.","_key":"3fcc731bdb492"},{"_type":"span","marks":["superscript"],"text":"2","_key":"8d14343a2de9"},{"_key":"6bed3b77c0bb","_type":"span","marks":[],"text":" Vermont was the only state to receive an A grade for its low preterm rate, with just 6 other states falling close behind with B ratings."},{"_type":"span","marks":["superscript"],"text":"1","_key":"3aba8982424c"},{"marks":[],"text":" Meanwhile, 20 states landed in the C category and 16 in the D category, while 8 states and Puerto Rico received Fs.","_key":"401036883815","_type":"span"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"86455b0d6cfe0"}],"_type":"block","style":"normal","_key":"b7f3e011a1cf","markDefs":[]},{"_type":"block","style":"h3","_key":"2a09f63caadb","markDefs":[],"children":[{"_type":"span","marks":[],"text":"How Did Vermont Jump From a B Rating to an A in 1 Year?","_key":"758a3b5c929e0"}]},{"children":[{"_key":"d4ec70c7c6660","_type":"span","marks":[],"text":"The state reported a preterm birth rate of 7.7% in 2023, which improved from the prior year when it was 8.8%—the highest it was since 2013—and is notably lower than the national average of 10.4%. Breaking it down by county, Chittenden, Franklin, Rutland, Windham, and Windsor all saw improvements, while the rate in Washington county worsened compared with last year’s report. Additionally, half these counties got Bs, with Rutland county having the highest rate of 9.1%."}],"_type":"block","style":"normal","_key":"e17a41c4cf1e","markDefs":[]},{"_key":"103822ab6bec","markDefs":[],"children":[{"text":"","_key":"f1afdc82fb560","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"There are a few factors that play into Vermont’s low preterm birth rate. First, the percentage of women having low-risk cesarean births in Vermont was 23.7%, comparable to the country-wide rate of 26.6%. Additionally, only 6.2% of birthing people were receiving inadequate prenatal care, much lower than the 15.7% rate across the US. 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Interestingly, the infant mortality rate among Black babies was 20% lower than the state average, highlighting nuanced trends in outcomes.","_key":"d1217dce06ee0","_type":"span"}],"_type":"block","style":"normal","_key":"2350a02d254c"},{"_type":"block","style":"normal","_key":"6ed4d8ddd5ca","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ae230c62c1560"}]},{"children":[{"marks":["strong"],"text":"Racial Gaps in Preterm Birth Rates","_key":"6cbaffb21d9a0","_type":"span"}],"_type":"block","style":"h3","_key":"c8f8728286ed","markDefs":[]},{"style":"normal","_key":"edbb0509f210","markDefs":[],"children":[{"marks":[],"text":"Disparities remain as the preterm birth rate varied by race and ethnicity. The preterm birth rate among babies born to Hispanic birthing people was 1.3 times higher than among all other groups in 2023, similar to the gap between Black birthing people and other groups across the country as a whole.","_key":"03649279c02b0","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c118090966590"}],"_type":"block","style":"normal","_key":"6430815c38ed"},{"style":"normal","_key":"02f513621a0c","markDefs":[{"_type":"link","href":"https://www.census.gov/quickfacts/VT#qf-headnote-b","_key":"17676e233da0","nofollow":true,"blank":true},{"_type":"link","href":"https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population/state/vermont/","_key":"31abd550b23f","nofollow":true,"blank":true}],"children":[{"_type":"span","marks":[],"text":"According to the report, Hispanic people in Vermont have a 52% higher preterm birth rate relative to Asian people, with rates of 10% and 6.6%, respectively. 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Hispanic and Latino individuals make up ","_key":"105e9dedc2e60"},{"_type":"span","marks":["17676e233da0"],"text":"less than 3%","_key":"105e9dedc2e61"},{"_type":"span","marks":[],"text":" of Vermont’s predominantly non-Hispanic White population.","_key":"105e9dedc2e62"},{"_key":"841aaf07e2fa","_type":"span","marks":["superscript"],"text":"4"},{"marks":[],"text":" However, the Hispanic population has ","_key":"bce3c00f0f44","_type":"span"},{"_key":"105e9dedc2e63","_type":"span","marks":["31abd550b23f"],"text":"grown the most"},{"_key":"105e9dedc2e64","_type":"span","marks":[],"text":" of any racial group in Vermont over the past decade, growing from 9291 in 2010, to 14,857 in 2022."},{"_type":"span","marks":["superscript"],"text":"5","_key":"8eb8cc942a9c"},{"_type":"span","marks":[],"text":" As the state’s population slowly grows more diverse, it’s important that health care policies in the state focus on protecting those at higher risk of having a preterm birth.","_key":"441e881f62a9"}],"_type":"block"},{"style":"normal","_key":"8400a03a6ae5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"fa766386ce4a0"}],"_type":"block"},{"style":"h3","_key":"cd1eed918ae3","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Chronic Health Conditions Increase Risk","_key":"1060d17085280"}],"_type":"block"},{"_type":"block","style":"normal","_key":"a31a5facd4e5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The report card also highlights the compounding risks faced by certain demographic groups when preexisting chronic health conditions intersect with systemic inequities. In Vermont, the influence of chronic conditions such as smoking, hypertension, unhealthy weight, and diabetes becomes more concerning.","_key":"9fa47c5da1a50"},{"_type":"span","marks":["superscript"],"text":"1","_key":"7f44ee413088"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e920808e9dcd0"}],"_type":"block","style":"normal","_key":"3a72bbd320ee"},{"style":"normal","_key":"2f9d37f5ac43","markDefs":[{"href":"https://www.healthvermont.gov/stats/population-health-surveys-data/behavioral-risk-factor-surveillance-system-brfss","_key":"4e7a0751c1d2","nofollow":true,"blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"State-level data showed that preterm birth rates rise to 13.8% for those with smoking-related conditions, 17.3% with hypertension, 8.3% with unhealthy weight, and 22.6% with diabetes. With 13% of the state’s population smoking, 32% having hypertension, 35% having overweight, 27% having obesity, and 8% having diabetes ","_key":"079eaca848dd0"},{"_type":"span","marks":["4e7a0751c1d2"],"text":"in 2022","_key":"079eaca848dd1"},{"_key":"079eaca848dd2","_type":"span","marks":[],"text":", it’s important to focus on preventive strategies to mitigate the risk of these conditions and, in turn, preterm birth."},{"text":"6","_key":"fbd0e1d65118","_type":"span","marks":["superscript"]}],"_type":"block"},{"_key":"afce8f9c9c0b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"929cefb3d4760"}],"_type":"block","style":"normal"},{"markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://jamanetwork.com/journals/jama/fullarticle/2806661","_key":"d6631574d717"}],"children":[{"_type":"span","marks":[],"text":"The report card credited mental health, substance use, and general health care as the primary factors that make Vermont patients more vulnerable to poor maternal outcomes.","_key":"aa6185fe47990"},{"_type":"span","marks":["superscript"],"text":"1","_key":"fdc68357e932"},{"text":" In 2019, Vermont was ","_key":"5b6a3291780f","_type":"span","marks":[]},{"_type":"span","marks":["d6631574d717"],"text":"one of few states","_key":"aa6185fe47991"},{"_key":"aa6185fe47992","_type":"span","marks":[],"text":" to have a lower maternal mortality ratio for all racial and ethnic groups, “suggesting that either underlying risk factors that drive maternal deaths are lower in these states or that prevention efforts have had some success in these locations,” according to researchers."},{"_type":"span","marks":["superscript"],"text":"7","_key":"57c8fe932ec3"}],"_type":"block","style":"normal","_key":"e59cf739ff87"},{"_type":"block","style":"normal","_key":"575a9e60d7e8","markDefs":[],"children":[{"marks":[],"text":"","_key":"a6d82e54d8a40","_type":"span"}]},{"markDefs":[],"children":[{"marks":["strong"],"text":"Ways Vermont Could Still Improve","_key":"37f7ff1ef9410","_type":"span"}],"_type":"block","style":"h3","_key":"3a993c08aa7a"},{"children":[{"_type":"span","marks":[],"text":"Despite having the lowest preterm birth rate in the country, there are a few policies Vermont does not have in place that could improve outcomes.","_key":"19df4bf4fba60"},{"_type":"span","marks":["superscript"],"text":"1","_key":"308cad193046"},{"marks":[],"text":" March of Dimes reported the state has only adopted 1 of 4 midwife policies that “support the growth and sustainability of the midwifery workforce.”","_key":"141026417d27","_type":"span"}],"_type":"block","style":"normal","_key":"34f1e32f5786","markDefs":[]},{"_key":"dfab23b06adf","markDefs":[],"children":[{"text":"","_key":"427d31c2bedc0","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"As previously mentioned, Vermont expanded Medicaid to allow birthing people more access to preventive care during pregnancy, in addition to extending coverage for women to 1 year postpartum. However, the state Medicaid program does not require nor reimburse for postpartum mental health screening, nor does it reimburse doula care. Vermont also does not require employers to provide a paid parental leave option according to the report card, and does not have a CDC-funded maternal mortality review committee that reviews fetal and infant deaths.","_key":"7379e24575340"}],"_type":"block","style":"normal","_key":"df26604d98fa"},{"_type":"block","style":"normal","_key":"c117ae727528","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"388d4b7cd0760"}]},{"_key":"51502ff748a7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"These state-level findings show how effective policies and investments can improve outcomes for birthing people and their infants. While the state sets an example with its low preterm birth rate and strong overall health rankings, addressing gaps in midwifery support, postpartum mental health care, and parental leave could further enhance Vermont’s standing as a national leader in maternal health.","_key":"b367e78aa2260"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"ca0c704f886b0"}],"_type":"block","style":"normal","_key":"7907d2573b6f","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"f34640a4c12b0"}],"_type":"block","style":"normal","_key":"d73f8a6152a0"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"2024 March of Dimes report card for United States. March of Dimes. November 2024. 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Accessed November 25, 2024. https://www.census.gov/quickfacts/VT#qf-headnote-b"}],"level":1,"_type":"block","style":"normal"},{"_key":"56ddb1979afa","listItem":"number","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Our changing population: Vermont.USA Facts. Updated July 2022. Accessed November 25, 2024. https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population/state/vermont/","_key":"247f4054060d0"}],"level":1,"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Behavioral risk factor surveillance system. Vermont Department of Health. January 2024. 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