P015 Rheumatology Patient Initiated Follow-Up (PIFU) in a busy urban district general hospital - a scoping exercise
Authors: Mothojakan Nadira , Aimee Louise St , Quieros Catriona , Horwood Natalie , Levy Sarah , Sathananthan Roshanthi 
Published: April 2022

Abstract

Background/Aims
A recent report from British Society of Rheumatology (2021) highlighted severe national shortages in the rheumatology workforce. Patient Initiated Follow-Up (PIFU) is an innovative strategy for stable patients, reducing the need for “routine follow-up”. PIFU allows patients to contact their local department and organise a clinical review if they have a disease flare. In our model, a back-up appointment is made to allow ongoing future management such as drug de-escalation. PIFU has been trialled successfully in other trusts, where 20% of follow-up patients were deemed suitable. Our aim was to perform a scoping exercise to determine if PIFU would be suitable for our multi-ethnic diverse cohort in a busy urban district general hospital.

Methods
PIFU inclusion, exclusion and disease-related criteria were developed with input from departments already running PIFU. Patients were considered for PIFU if over 18 years old with a diagnosis of stable inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, axial spondyloarthropathy) evidenced by low disease scores, no change in disease modifying drugs or steroid use in the last 12 months. Our criteria were applied retrospectively to all patients who attended consultant and registrar General Rheumatology clinics from 20th-31st January 2020. Data were collected on demographics, rheumatological diagnosis and suitability of eligible patients for PIFU.

Results
340 follow-up patients attended clinic during the 2-week period, of which 136 did not have a rheumatological condition suitable for PIFU (including osteoporosis, osteoarthritis and connective tissue disease). 42 (20.6%) of the 204 patients with eligible conditions were deemed suitable for PIFU. This represented 12.4% of our total follow-ups. In our current practice, the routine follow-up for the 42 suitable patients was arranged for a median time of 9 months (IQR: 7.75-12 months). If PIFU patients were allocated a back-up appointment at 3 years, PIFU would represent a saving of 3 routine appointments per patient over 3 years. For a full-time consultant, seeing 40 follow-ups per week, this would save 4.9 appointments per week or 198 appointments per year.

Conclusion
12.4% of our follow-up patients were deemed eligible for PIFU, which was lower than other trusts. This may be due to the low sample size or increased diversity and social complexity of our local population. Even with this lower percentage of eligible patients, PIFU may allow freeing of nearly five appointments per full-time consultant per week. PIFU may also empower patients to take ownership of their condition and enable confidence in self-management. If a PIFU service was set up locally, a robust pathway would be needed to ensure that patients could contact the department when required. The need for annual disease review would also need to be considered using primary care or IT solutions.

Disclosure
N. Mothojakan: None. L. St.Aimee: None. C. Quieros: None. N. Horwood: None. S. Levy: None. R. Sathananthan: None.