APPs Uniquely Positioned in ILD Collaborative Care, With Jessica Glennie, MSN, APRN

Interstitial lung disease (ILD) presents 1 of pulmonary medicine's most complex management challenges — requiring input from pulmonology, rheumatology, cardiology, and radiology to accurately diagnose and treat, while also demanding sustained, time-intensive patient communication across a continuum that can include antifibrotic therapy, pulmonary hypertension management, transplant evaluation, and palliative care. For advanced practice providers (APPs) working in this space, that complexity is precisely where they add value, according to Jessica Glennie, MSN, APRN, of the Cleveland Clinic ILD Center in Cleveland, Ohio.

Glennie spoke with HCPLive during the Association of Pulmonary Advanced Practice Providers (APAPP) National Conference, held June 28-20 in Colorado Springs, where she presented as part of a multidisciplinary ILD bootcamp that brought together pulmonary, rheumatology, cardiology, and radiology APPs to address the full clinical picture of ILD management. The multidisciplinary team (MDT) approach has become a cornerstone of ILD diagnosis and ongoing management, supported by evidence that integrated collaboration among pulmonologists, radiologists, pathologists, and rheumatologists improves diagnostic confidence and guides treatment decisions.^1,2

A recurring theme in the bootcamp was early recognition. ILD often first presents with subtle, nonspecific symptoms — dyspnea, cough — that can easily be attributed to more common conditions such as heart disease or obstructive airways disease.

"At first we might think of more common things like heart disease or airways-related things like COPD rather than interstitial lung disease," Glennie said. Getting clinicians across specialties to recognize those early presentations and route patients appropriately is a central aim of the multidisciplinary approach.

Beyond diagnosis, Glennie emphasized the sheer scope of what ILD patients need to understand and manage: the disease itself, its prognosis, treatment options and associated toxicities, comorbidities including pulmonary hypertension, and — for some — lung transplant evaluation and end-of-life planning. APPs, she noted, are often better positioned than physicians to provide that sustained engagement.

"APPs oftentimes have a little bit more time to devote to that patient — available in different ways, via phone or virtual visits — and I'm able to offer a little bit more time in the office," she said. "They can really offer a lot of help along that continuum of care with that patient."

For APPs who don't work in dedicated ILD centers, Glennie offered practical guidance on bridging the gaps that can emerge when complex patients move between specialties: build relationships with radiologists and rheumatologists at your institution, know who in your area has ILD experience, and cultivate the referral networks that can keep patients from being lost between providers. She described APAP's national conference as a key vehicle for that kind of networking — enabling APPs to identify colleagues across subspecialties they can call on when navigating difficult cases.

Glennie has no relevant disclosures to report.

References

1. Cottin V, Martinez FJ, Smith V, Walsh SLF. Multidisciplinary teams in the clinical care of fibrotic interstitial lung disease: current perspectives. Eur Respir Rev. 2022;31(166):220003. doi:10.1183/16000617.0003-2022

2. Guler SA, et al. Interdisciplinary diagnosis and management of patients with interstitial lung disease and connective tissue disease. Chest. 2024;166(4). doi:10.1016/j.chest.2024.02.049