POS1478-HPR NURSE LED REMOTE MANAGEMENT OF OSTEOPOROSIS – DO PATIENTS APPROVE?
Authors: J. Begum, J. Fourmy, M. K. Nisar
Journal: Annals of the Rheumatic Diseases (2021)

Background: Specialist services are heavily reliant on consultant delivered models however lack of sufficient consultant appointments pose a significant operational challenge. Clinical nurse specialists (CNSs) are highly trained and can fill this gap whilst maintaining a high standard of care. Objectives: We designed an innovative proof-of-concept osteoporosis service with patients only consulting a metabolic bone CNS and a consultant providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits whilst continuing to deliver high-quality care. Methods: A new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a consultant-CNS virtual MDT. Appropriate parenteral treatment option was agreed and confirmed to each individual. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. We surveyed 100 consecutive patients to gain their feedback regarding the service using a ten-item questionnaire employing binary and Likert scale options. Results: The questionnaire was posted to 100 patients. Mean age of participants was 77.2 years (65-92). 75 returned the survey. 67 (89%) were happy with the waiting time and seventy (93%) found thirty-minute appointment acceptable. 66 (88%) were happy with the phone consultation and agreed that the care plan was adequately explained. 73 (97%) were happy for the CNS review in future and would recommend the service. 67 (89%) were satisfied with the overall service. Though most (95%) were able to take the call maintaining privacy, eleven (15%) participants would’ve found physical appointment more convenient. When asked which medium they would prefer for future reviews, only fifty (66%) patients would keep telephone as their choice. Sixteen (21%) would prefer face to face consultation, seven (9%) a combination of the two and only two would choose online option. Conclusion: To our knowledge, this is the first successful example of an innovative service wholly provided by CNSs. Most patients were satisfied with this model of care and would highly recommend it. They were happy to be reviewed by CNS in the future. However a significant minority did not like the remote element and a higher proportion would choose physical review in future if offered. Interestingly, telephone consultation still scored substantially higher than online platform despite being physically visible in the latter. This is intriguing as most remote services strive for online consultations assuming its preference to phone. Our study suggests against this notion certainly in older patient group. Overall, a nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution though remote consultations may not be the optimal delivery model. Disclosure of Interests: None declared