PA27 Patient-initiated follow-up in an Irish dermatology department: a pilot study

Abstract

Abstract Patient-initiated follow-up (PIFU) is an alternative approach to a traditional appointment-based system, offering flexible review for patients, and has successfully been implemented across a range of specialty departments worldwide. In 2022, the Health Service Executive in Ireland announced reforms to introduce ‘patient-initiated review’ across the organization in its strategy to tackle long patient waiting lists. More recently, the British Association of Dermatologists developed guidelines to support dermatology departments within the National Health Service to introduce PIFU pathways successfully. We performed a single centre, prospective pilot study of patients offered PIFU over a 3-month period in 2021. Patients were identified through electronic reports for adult and paediatric dermatology clinics, and data were drawn from clinical records. Patients were offered ‘flexible’ review within 1 year of the original presentation pertaining to the same clinical condition. Patient demographics and clinical details were extracted and analysed, and patients followed for a 12-month period. Forty-seven patients were identified. Fifty-seven per cent (n = 27) were female and the median age was 23 years (range 0–83). Clinical diagnoses included acne (n = 13), eczema (n = 8), nonspecific rash (n = 4), infection (n = 5), nonmelanoma skin cancer (n = 3), urticaria (n = 2), hidradenitis suppurativa (n = 2), actinic keratosis (n = 2), guttate psoriasis (n = 2), vasculitis (n = 2) and other (n = 4). Thirty per cent (n = 14) of patients activated PIFU within a 12-month period. Median time until PIFU was 213 days (range 28–413). Fifty-seven per cent (n = 8/14) were paediatric patients. Forty-three per cent (n = 6/14) of patients had acne, 29% (n = 4/14) eczema, 14% (n = 2) actinic keratosis, 7% (n = 1), urticaria and 7% (n = 1) guttate psoriasis. The background rate of patients who ‘did not attend’ (DNA) in 2021 was 12% (n = 823/7093). This study demonstrates how PIFU has a useful role in reducing unnecessary attendance at outpatient clinics. Previous research has demonstrated its benefits in patients with chronic conditions who require lifelong management. Our findings support the view that PIFU has a role in dermatology for patients with conditions that display periods of quiescence, as seen in inflammatory dermatoses. Early review allows for the appropriate escalation of treatment to avoid potential complications. This study shows that PIFU can have a positive impact on DNA rates. In 2021, the departmental DNA rate was lower than the estimated annual national rate of 13%. The PIFU avoids unnecessary review of well patients, reducing the potential for nonattendance. Furthermore, 70% of patients were successfully discharged after 12 months. The PIFU may complement strategies such as nurse-led clinics and teledermatology in increasing outpatient capacity and reducing patient waiting lists. Further larger studies focusing on client and resource benefits of PIFU can guide specialty-specific policies for its use across institutions in the future.