TO “network” the centers of excellence where there is the presence of quality multidisciplinary teams, to encourage the transition to digital medicine and to “make culture”. These are the three points on which to intervene to better treat interstitial lung disease (ILD), complications that can occur in patients with autoimmune rheumatological diseases and cause serious consequences. This is why it is essential to act promptly, to identify them as soon as possible. Unfortunately in Italy this does not always happen: in our territory experiences of multidisciplinary collaboration of true excellence alternate with situations of serious deficiencies. This is what emerged from the meeting “Towards an organizational proposal of a Multidisciplinary Team in the diagnosis and treatment of ILD in patients with MRA”, organized by ISHEO, with the unconditional contribution of Boheringer Ingelheim Italia SpA, as part of the RETE-ILD project .
The project was born to promote and implement, on the national territory, the activity of multidisciplinary teams and in this phase saw an intense debate between rheumatologists, pulmonologists, radiologists and internists, representatives of excellent initiatives on the national territory. The RETE ILD project will network the identified centers, will build opportunities for debate and training projects to share best practices and create culture, especially for those areas where rheumatology and / or pulmonology centers are not well represented. In this way it will be possible to build a connection bridge with well-organized realities.
“The multidisciplinary approach is undoubtedly fundamental, but it is necessary that the support of the specialist involved in the team is adequate to allow for a valid discussion – said Roberto Gerli, President of the Italian Society of Rheumatology (SIR) -. In some areas there is the presence of a more developed rheumatology net of a weaker pulmonology and / or radiology, or vice versa. It could be useful to set up teams that can take advantage of external support, through web-based methods, to make up for the shortcomings present in certain areas. It is necessary to propose concrete projects precisely in the light of the imbalances present in the area. It would be useful initially to identify the centers that already have developed rheumatology, pulmonology and radiology in order to start creating efficient regional and / or macro-regional realities. Therefore, start from realities that already boast structured centers and then broaden the horizon “.
“The shortcomings on the national territory are a reality now known to clinicians – stated Alfredo Sebastiani, Director of UOSD DH Pneumology and Pulmonary Interstitial Diseases of the San Camillo-Forlanini Hospital in Rome -. The critical issues present concern the homogenization of the presence of multidisciplinary teams throughout Italy. This reality is primarily affected by the non-homogeneous presence throughout the national territory of the reference figures, namely the pulmonologist and the rheumatologist, as well as the specialized radiologist, an important shortage throughout the country. There is also a strong further criticality linked to the lack of communication which can however be overcome by opting for digital medicine models already implemented for other clinical conditions. Gathering territorial networks through communication between scientific societies or reference specialists could be a starting point for building a valid communication network. Joint surgery models and detailed PDTAs represent a hope of being able to really build organized models, but it should be remembered that these PDTAs, while representing a valid initial tool, must be implemented in this large existing heterogeneity. It would be useful to optimize what is already present on the territory, enhancing the figure of the coordinator of reference who must take on the burden of planning the activities ensuring the functionality and continuity of the team “.
“The need to adopt a common language to favor the presence and correct management of multidisciplinary teams, the identification of digital tools for sharing and telematic interaction – concludes Davide Integlia, Director of ISHEO srl – are the elements to be able to build a winning strategy to support the less organized realities today. These assumptions represent the direction in which the RETE ILD project will continue which, through a series of meetings at national and regional level, aims to create a vademecum containing organizational criteria and standards to support the management of multidisciplinary teams for early diagnosis and correct taking care of patients with autoimmune rheumatological diseases and lung involvement “.
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