P89 Can we manage osteoporosis without patients ever seeing a consultant?

Abstract

Abstract Background Specialist services are heavily reliant on a consultant reviewing a patient and discussing management options. 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 a high-quality and safe service. Methods All stakeholders involved in the management of osteoporosis at our unit were engaged. Following extensive discussions, a new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged post menopausal women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation and assess the suitability of parenteral treatment. 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 everyone. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. If all checks were satisfactory, the treatment was commenced, and individuals advised to contact the advice line for any concerns. There was no face-to-face appointment in the service unless explicitly requested by the users. Results In the proof-of-concept phase, 38 patients were triaged into the new service. It was a combination of sixteen new referrals and 22 patients pulled from the consultants’ waiting list. Mean age of participants was 77.2 years (65-92). Referral to virtual triage took median 20 days (0-62). Median time for triage to new patient CNS telephone consultation was 18 days (6-87). Time to virtual MDT for treatment authorisation was median zero days (0-76 days). 17 patients had anabolic therapy commenced via home care. Remaining had anti resorptive therapy. No patient requested face-to-face review. Only one patient fed back that they would’ve preferred to see the consultant once. 38 new patient consultant appointments were saved and median delay in treatment commencement was reduced from 84 to 38 days. Conclusion To our knowledge, this is the first successful example of an innovative service wholly provided by CNSs for commencing parenteral anti-osteoporotic therapy with only remote consultant supervision. Our service redesign has significantly improved the efficiency of the parenteral osteoporosis pathway with reduction in treatment delay and a more streamlined patient journey. A nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution to thinly stretched health care needs of people with chronic conditions. Disclosures J. Fourmy None. J. Begum None. M.K. Nisar None.