Expanding ILD Care Access Through Shared Models and Telehealth: Yet Khor, MD, PhD

Access to tertiary centers and pulmonology specialists in interstitial lung disease (ILD) and pulmonary fibrosis (PF) care is a large barrier patients face today. Addressing these barriers was a key point made at the American Thoracic Society 2026 International Conference in Orlando, Florida, from May 17-20, 2026.

Partnering with community advocacy groups can help spread patient awareness on newer therapies and clinical trials and broaden access, one of the panelists, Yet Khor, MD, PhD, an associate professor in immunology research at Monash University, said in an interview with The American Journal of Managed Care^® (AJMC^®).

In this Q&A, Khor explains how community and specialty oncologists can work together to address disparities within ILD and PF care.

This transcript was lightly edited for clarity.

AJMC: Much of ILD expertise is concentrated in tertiary academic centers like the University of Melbourne and Monash University. What are the most realistic strategies for extending that expertise into community and regional settings without diluting the quality of care?

Khor: Typically, the ILD specialist care is concentrated in metropolitan areas where all these university-affiliated health services are, but there's a limit to how many patients can come through those systems. I think it's potentially a shared care model where there's a local community of pulmonologists that can be involved in patient care, who live closer to the patients and will be able to address immediate issues the patients may have. For instance, if they develop acute infections or adverse drug reactions, allowing that to happen is trying to upskill the community pulmonologist.

What we do a lot is to have a shared care model where we alternate seeing the patients every 3 months. In that way, the community pulmonologists also have experience with seeing ILD patients and exposure to immunosuppressants or antifibrotics that they may not be as comfortable using at the beginning. And subsequently, with increasing this kind of arrangement, they get experience understanding what to expect, what they need to look out for, and that increases their confidence in looking after these patients and reaching out to tertiary care as a next step action if needed.

AJMC: What are the biggest structural barriers limiting trial enrollment today—patient awareness, referral pathways, eligibility criteria, or something else?

Khor: One of the biggest barriers is patient awareness, and it's similar across different countries. The vast majority of phase 2 or 3 clinical trials are all done in tertiary care centers, and we still rely a lot on the face-to-face interaction with patients—explaining what the trial is and trying to recruit patients that way. But if we look at the whole population, there’s only a very small portion that actually ever reaches specialist care. Some of the patients will get stuck with the local pulmonologist, or they will be in the community centers.

There's a bigger pool of patients who are never aware that there are clinical trials that are available that might be changing their outcomes by allowing earlier access to novel therapies. It's important to think about how we're going to start increasing patient awareness that's going to reach the community and reach everyone, and not just those who have been seen in the tertiary care centers.

AJMC: How do access disparities in supportive therapies like oxygen intersect with broader inequities in pulmonary fibrosis outcomes and quality of life?

Khor: It's one of the biggest inequalities across different countries or different regions, and even within the same country. For instance, in Australia, in different states, there are different registrations, funding, and systems. This is something that we should partner with patients on because their voice is important to partnering with patient advocacy groups and advancing research in this area.

Having the evidence base where we can go forward and partnering with patient advocacy to raise the awareness and the importance of these interventions and what they mean for patients so policymakers and government agencies are able to change the funding rules and policy regarding access to different supportive care therapies.

AJMC: What role do you see telehealth and digital tools playing in improving equity in ILD care, particularly for patients who are geographically isolated or under-resourced?

Khor: Telehealth and digital tools have had a big uptake since the COVID pandemic, especially in Australia. In Melbourne, specifically, where I work, we had a 9-month period where we were able to see patients, and patients weren’t able to travel as well. It does have the potential and the capability of reaching patients, especially to remove the travel barrier, so patients would not have to travel as often to tertiary care.

But it's important to bear in mind that there’s a potential for different inequalities that are going to be introduced by digital health and technologies. It's going to open up a different kind of disparity in terms of access. These tools do come with a cost; some more well-resourced health services will be able to offer a better service with better infrastructure and the availability of manpower to run these services. And there will be patients who are unable to participate in these kinds of activities because of broadband access issues—depending on the rurality of their location, Wi-Fi and internet access can still be an issue.

Even as we’re moving forward with digital health or telehealth, the traditional face-to-face way of managing patients will always be around, and hopefully, they’ll complement each other. And some patients will be very well suited for digital health and telehealth, and some patients will still need to be careful in the traditional pathway, and the other thing to consider is patients' experience.

A lot of the time, patients value the face-to-face interactions, even though the technology gets better every day. One day, the virtual health setting may be more relevant in terms of performing consultations, but there are still limitations in terms of a physical examination and discussion about the most sensitive issues that some patients still prefer to have done face-to-face. I think a hybrid model and offering patients opportunities or choices when they choose to come to see you in person is still important.