Appointment Duration Research Articles

Student and physiotherapists' perceived abilities to prescribe effective physical activity and exercise interventions: A cross-sectional survey.

Physical activity, aerobic and resistance training have established benefits to health and wellbeing, with physiotherapists playing a vital role in their promotion. To capture UK student and graduate physiotherapists (1) knowledge of accepted guidelines and, (2) perceptions of physical activity and exercise prescription in practice. National cross-sectional online survey. A survey was conducted online among UK student and graduate physiotherapists from July to December 2021. Quantitative questions included dichotomous (yes/no), multiple-choice, and Likert scale (1-5) formats, alongside open-ended qualitative questions. Of 305 respondents (18% students, 47%>10 years' experience), 295 (97%) either "agreed" (n=64, 21%) or "strongly agreed" (n=231, 76%) that physical activity was a part of their role. Less than half felt the physiotherapy profession was able to provide effective physical activity (n=149, 49%, 95% confidence intervals 43 to 54) and aerobic training (130, 43%, 37 to 48). Most knew the weekly minimum adult dosage of physical activity (257, 84%, 80 to 88) and resistance training (267, 88%, 83 to 91) but were generally unable to correctly identify aerobic and resistance training guidelines. Of those who used evidenced based guidelines regularly with patients 72% were not adopting correct guidelines for aerobic (n=58, 72%, 61 to 80) and 46% for resistance training (n=45, 46%, 36 to 56). Limited patient appointment duration, inadequate access to facilities and a lack of continuous professional development opportunities were perceived barriers to implementation. Respondents agreed physical activity and exercise are vital treatment modalities, however many lack the knowledge to deliver these interventions in line with contemporary guidelines.

First Contact Physiotherapy: A 4-Year Service Evaluation of UK Primary Care Data.

The First Contact Physiotherapist (FCP) role offers patients direct access to musculoskeletal (MSK) specialists in primary care settings and is designed to reduce GP workload while providing high-quality care. Despite positive early evaluations of FCP services, there remains a need for up-to-date assessments of their impact. To evaluate the FCP model of care implemented in an NHS Primary Care Network (PCN) against pre-defined service objectives. A service evaluation was conducted using data from April 2020 to March 2024. Key performance indicators were based on national FCP evaluation criteria. Data included appointment utilisation, wait times, referral patterns, patient and staff satisfaction surveys, and audit results from clinical data. Over 4years, 12,185 patients were seen. Of these, 69% of patients were seen as true first contacts. The majority of patients (86.4%) were managed within primary care, with a referral rate of 8.5% to outpatient physiotherapy and 5.1% to orthopaedics. Patient satisfaction was high, with 82% rating their FCP experience as excellent or outstanding. The FCP service successfully met its objectives by reducing GP workload and providing effective care. However, there was an increase in outpatient physiotherapy referrals over the 4-year period. Staff satisfaction was generally positive, though some highlighted concerns about appointment duration and workload. This evaluation demonstrates that FCP services provide a viable solution for managing MSK conditions in primary care. Future research should explore the most effective MSK service delivery models and incorporate digital solutions for comprehensive outcome and experience measures.

Abstract P319: Organizational Determinants to Hypertension Management: A Qualitative Examination at Two Academic Learning Health Systems

Background: Hypertension management is a national priority. However, hypertension control rates are suboptimal and vary across clinics, even among those in the same health system and geographic region. Objective: To identify organizational barriers and facilitators that impact hypertension management at the provider- and clinic-level. Design: Semi-structured interviews were conducted with primary care providers (N=25) and patients with uncontrolled hypertension (N=22). Participants were recruited from thirteen family and internal medicine clinics across two academic learning health systems. Participants: Twenty-five providers and twenty-two patients were recruited from clinics across North Carolina and Kansas. Approach: Interviews were analyzed using both inductive and deductive coding methodologies. A health equity framework scaffolded interview guide design and codebook development, with thematic analysis employed to categorize emergent themes across the four framework domains. Key Results: Participants discussed organizational and clinic-level barriers and facilitators that impact hypertension management, with health systems’ resource centralization being frequently mentioned. Some participants lauded centralized interventions for improving patient access and increasing touchpoints, while others lamented reductions in their clinic’s staffing to accommodate centralized workflows. Insufficient in-clinic staffing and blood pressure (BP) measurement equipment, limited exam rooms, short appointment duration, and hurried clinic environments were all mentioned as challenges to hypertension management, particularly as they hindered adherence to BP recheck policies. Appointment availability was mentioned as a barrier, however providers referenced clinics’ use of virtual and/or nurse-specific visits as a mechanism to increase patient access. Multiple providers noted that tasks central to hypertension management, like BP telemonitoring and MyChart correspondence, go unaccounted for on their schedules and can lead to unpaid work, which they linked with increased stress and burnout. Conclusions: Primary care clinics experience multiple interrelated organizational barriers to effective hypertension management. Future studies should examine the impact of different clinic staffing models, including multidisciplinary care teams, telemedicine, and remote BP monitoring, on BP outcomes in diverse primary care settings.

O01 LISTEN TO YOUR HEART AND MIND: A FEASIBILITY STUDY ON COMBINED SCREENING OF RAISED BLOOD PRESSURE, ATRIAL FIBRILLATION, COGNITIVE IMPAIRMENT AND HEARING LOSS

Background and Objective. Detection rates of hypertension continues to be suboptimal worldwide. The risk of hypertension increases substantially in older adults aged ≥65 years, a group also at increased risk of atrial fibrillation (AF), cognitive decline and hearing loss—all factors associated with hypertension. This pilot study aimed to 1) implement a combined screening strategy for these health conditions, and 2) assess feasibility and acceptability of the combined screening. Methods. Adults aged ≥65 years without a prior diagnosis of cognitive impairment and dementia were invited to attend a combined screening appointment through advertisements posted in university and community group newsletters and noticeboards. Participants underwent blood pressure (BP) and AF screening using an oscillometric BP monitor with AF detection (Microlife WatchBP Office 2G), cognitive assessment (General Practitioner Assessment of Cognition, GPCOG), and audiometric testing. A subset of participants was invited to participate in a post-study process evaluation interview. Results. Of the 35 participants (age 73±6 years, 51% females), 26 (74%) had hypertension (on antihypertensive medication: n=20; measured: n=6; unaware: n=2; uncontrolled: n=4). Possible AF was detected in two participants and seven had possible cognitive decline (GPCOG score <9). Hearing loss was detected in 13 participants. Interviews (n=16, 50% females) revealed that combined screening was acceptable and feasible as participants felt it was “convenient”, “saves time”, “a brilliant idea”, and that “… conditions are related and therefore appropriate to be together”. Most participants were already aware of their hypertension status, thus screening did not result in increased hypertension awareness except for one with uncontrolled hypertension who proceeded to purchase a home BP monitor. One participant with detected AF visited a cardiologist and confirmed non-AF arrhythmia. All interviewees found the appointment duration (approximately 60-75 minutes) was not too long nor too taxing. Conclusions. Combined screening in older adults with increased cardiovascular risk is feasible and acceptable and should be considered for future screening programs in older adults.

My hearing explained for children: exploring use of this discussion tool in clinical practice

Objective To explore the clinical use of ‘My Hearing Explained for Children’ (MHEfC) with children aged 8-11 years, from the perspectives of the child, parents and audiologist. Design A mixed methods randomised control trial. Participants completed evaluation questionnaires after their appointment. Statistical and thematic analyses were used to examine the rating scale and open response elements of the questionnaires respectively. Study sample 45 families participated, 24 randomised to MHEfC and 21 to standard care. Results Use of MHEfC increased the appointment duration by 8.2 minutes (95% CI 4.1 to 14.2 minutes), which was acceptable to parents (96%) and audiologists (67%). It promoted conversation around ‘behavioural and communication tactics’, ‘specific listening situations’ and ‘listening effort’ at the expense of ‘anatomy/physiology/aetiology’. MHEfC positively impacted the discussion of test results (54%); ease of finding joint solutions to problems (71%); and the nature of issues and management options discussed (54%). Parental satisfaction with discussion was high on both pathways, so some parents and audiologists questioned MHEfC necessity and recommended targeted use in future. Conclusions MHEfC was acceptable to children (70%) and parents (86%). It successfully promoted child-centred topics of discussion and can positively impact discussion outcomes.

Optimized, Person-Centered Workflow Design for a High-Throughput Breast MRI Screening Facility-A Simulation Study.

This project aims to model an optimal scanning environment for breast magnetic resonance imaging (MRI) screening based on real-life data to identify to what extent the logistics of breast MRI can be optimized. A novel concept for a breast MRI screening facility was developed considering layout of the building, workflow steps, used resources, and MRI protocols. The envisioned screening facility is person centered and aims for an efficient workflow-oriented design. Real-life data, collected from existing breast MRI screening workflows, during 62 scans in 3 different hospitals, were imported into a 3D simulation software for designing and testing new concepts. The model provided several realistic, virtual, logistical pathways for MRI screening and their outcome measures: throughput, waiting times, and other relevant variables. The total average appointment time in the baseline scenario was 25:54 minutes, with 19:06 minutes of MRI room occupation. Simulated improvements consisted of optimizing processes and resources, facility layout, and scanning protocol. In the simulation, time spent in the MRI room was reduced by introducing an optimized facility layout, dockable tables, and adoption of an abbreviated MRI scanning protocol. The total average appointment time was reduced to 19:36 minutes, and in this scenario, the MRI room was occupied for 06:21 minutes. In the most promising scenario, screening of about 68 people per day (10 hours) on a single MRI scanner could be feasible, compared with 36 people per day in the baseline scenario. This study suggests that by optimizing workflow MRI for breast screening total appointment duration and MRI occupation can be reduced. A throughput of up to 6 people per hour may be achieved, compared with 3 people per hour in the current setup.

A Cross-Sectional Survey of Fixed-Dose Combination Antihypertensive Medicine Prescribing in Twenty-Four Countries, Including Qualitative Insights.

Treatment inertia, non-adherence and non-persistence to medical treatment contribute to poor blood pressure (BP) control worldwide. Fixed dose combination (FDC) antihypertensive medicines simplify prescribing patterns and improve adherence. The aim of this study was to identify factors associated with prescribing FDC antihypertensive medicines and to understand if these factors differ among doctors worldwide. A cross-sectional survey was conducted online from June 2023 to January 2024 to recruit doctors. We collaborated with an international network of researchers and clinicians identified through institutional connections. A passive snowballing recruitment strategy was employed, where network members forwarded the survey link to their clinical colleagues. The survey instrument, developed through a literature review, interviews with academic and clinical researchers, and pilot testing, assessed participants perspectives on prescribing FDC antihypertensive medicines for hypertension. Participants rated their level of agreement (5-point Likert scale) with statements representing six barriers and four facilitators to FDC use. Data from 191 surveys were available for analysis. 25% (n = 47) of participants worked in high-income countries, 38% (n = 73) in upper-middle income, 25% (n = 48) in lower-middle income, 6% (n = 10) in low-income countries. Forty percent (n = 70) of participants were between 36-45 years of age; two thirds were male. Cost was reported as a barrier to prescribing FDC antihypertensive medicines [51% (n = 87) agreeing or strongly agreeing], followed by doctors' confidence in BP measured in clinic [40%, (n = 70)], access [37%, (n = 67)], appointment duration [35%, (n = 61)], concerns about side-effects [(21%, n = 37)], and non-adherence [12%, (n = 21)]. Facilitators to FDC antihypertensive polypills prescribing were clinician facing, such as access to educational supports [79%, (n = 143)], more BP measurement data [67%, (n = 120)], a clinical nudge in health records [61%, (n = 109)] and patient-facing including improved patient health literacy [49%, (n = 88)]. The levels of agreement and strong agreement across all barriers and facilitators were similar for participants working in higher or lower income countries. Across all countries, participants rated FDC antihypertensive medications highly valuable for managing patients with non-adherence, (82% reported high or very high value), for patients with high pill burden (80%). Cost and access were the most common barriers to prescribing FDCs across high- and low-income countries. While greater educational support for clinicians was perceived as the leading potential facilitator of FDC use, this seems unlikely to be effective without addressing access.

The COVID‐19 pandemic and primary care appointment availability by physician age and gender

AbstractUsing data generated through simulated patient calls to a national random sample of primary care physicians between February and July 2020, we examine the effects of the first wave of COVID‐19 on the availability of the U.S. primary care physician workforce for routine new patient appointments. As states enacted stay‐at‐home orders, physicians overall became less selective by insurance, and there was a 7 percentage‐point increase in acceptance of patient insurance. Telemedicine appointment offers increased 10.2 percentage points from near zero. However, relative to younger counterparts, physicians older than the sample mean (53.1 years) became 18.1 percentage points less likely to offer appointments and decreased their estimated appointment duration by 7.1 min. Compared to male physicians, female physicians became 10 percentage points more likely to accept new patients. These insights into appointment offers during the first wave of COVID‐19 may help policymakers seeking to ensure an adequate physician workforce during future crises.

Optometric Management of Concussion in Canadian Private Practice

Purpose The purpose of this study was to determine the current prescribing and assessment practices of optometrists in Canada seeing patients with persistent concussion-associated vision deficits. Methods A 6-question electronic survey was distributed to provincial and national boards of optometry in Canada. Questions pertaining to vision assessment, prescribing habits, daily living advice, appointment duration and follow-up appointment(s) were included. Practicing optometrists in Canada who have or have not managed concussion patients were eligible to complete the survey. Analysis consisted of categorizing and analyzing the frequency of responses provided. Results A total of 199 responses were received of which there were 142 completed responses (including 1 blank response). Of these, 13 optometrists indicated that they did not manage concussion. Of the 128 optometrists who indicated that they managed concussion 98% did a full eye exam. Visual acuity was assessed 96% of the time. Other frequent assessments were dry refraction 91%, pupil dilation 80%, and full binocular vision assessments 78%. Most respondents, 116, indicated that they provided advice on daily living activity and the most frequent advice was to limit activity, 64% (74/116). Responses were offered by 121 optometrists on appointment duration. Most frequently optometrists stated concussion appointments lasted between 30-60 minutes (69/121). Responses on follow-up were given by 119 optometrists and the most frequent follow-up was 1-2 months (27/119). Conclusion The results from this study provide insight on how optometrists in private practice are managing vision deficits following concussion. Further research on treatment effectiveness is required to develop an optometric protocol for the management of vision in patients with persistent concussion symptoms.

Analysis of Value Dimensions in Public Satisfaction with Primary Health Care: Prospective Observational Study

Background. Artificial neural network models can be used to analyze and predict structural components within the value dimension of the main processes in an outpatient clinic as indicators of patient satisfaction.Objective — to form and test the methodology for analyzing and predicting structural components within the value dimension of the main processes in an outpatient clinic, as indicators of patient satisfaction with availability and quality of medical care, using artificial intelligence.Methods. The results of questionnaires administered to 525 patients were used to analyze their satisfaction with GP appointments. A network ensemble consisting of radial basis network and multilayer perceptron was chosen as the basis for a neural network model. The model testing involved five outpatient clinics in Kirov. The total number of respondents comprised 217 patients. Statistical processing included data description and analysis. Qualitative attributes were represented by relative values (P, %). The statistical significance of differences in qualitative data was assessed using the Chi-square test. The correlation between the observed and predicted data was assessed by means of nonparametric Spearman correlation analysis. The value of p <0.05 was chosen as the significance level ( p). Statistical data processing was performed using Statistica 13.0.Results. Analysis of the value dimensions of satisfaction showed a predominance of “pre-appointment” stage: work of a registrar (85.29% significance in the receiving medical services), waiting time for an appointment with a doctor (66.76% respondents noted its significance), duration of waiting directly at the office (important for 69.11% of respondents). “Appointment” stage was formed according to the common procedure of a GP appointment (interview, examination, recommendations) and was assessed from the value perspective of the patient. The priority components included sufficiency of appointment duration (significant in 88.27% of cases), satisfaction with examination (significant in 85.14% of cases), as well as completeness and informativeness of consultation (significant in 89.9% of cases). A strong direct correlation between the observed and predicted data (ρxy = 0.9; p < 0.05) was found out. Statistically significant differences between the observed and predicted levels of general patient satisfaction were not revealed in all medical organizations.Conclusion. The suggested neural network models can be used as the basis when creating information management systems that monitor meeting the effectiveness criteria for a new model of a medical organization; as well as an essential support for administrative decisions related to organizing the optimal patient management.

Improving Staff Workflow in Urology Procedure Clinic Using the Model for Improvement

To maximize procedure volume and minimize workflow inefficiency in our urological procedure clinic, we hypothesized that for staff (nurses/medical assistants) and patient teams, team workflow duration (TWD) (the time required to complete team duties for a single appointment) could be reduced by 50% with a targeted workflow intervention developed using the Model for Improvement and Plan-Do-Study-Act cycles. Workflow inefficiency leads to wasted time and workplace dissatisfaction, resulting in lost revenue due to low procedure volume and high staff turnover. A baseline time study was performed to measure TWD for clinical teams, including the front desk, physician, staff, and patient teams. Implementation of previously identified interventions was also recorded. A workflow intervention was developed in which staff duties were split among two roles: staffer and triager. TWD and intervention implementation were remeasured over six Plan-Do-Study-Act cycles. Semistructured interviews were conducted as a balance measure to assess impact on staff workflow and wellness. Our workflow intervention resulted in a 44% and 42% reduction in staff and patient TWD, saving nearly 17minutes per appointment on average. Thematic analysis revealed that time saved could be best used to protect lunch breaks and allow time to complete nonclinical duties such as patient calls, which had previously been performed after-hours. Introduction of staffer and triager roles to staff workflow increased clinic efficiency by reducing workflow and procedure appointment duration. Time saved was used to increase procedure volume while also supporting staff wellness.

Online scheduling using a fixed template: the case of outpatient chemotherapy drug administration

In this paper, we use a fixed template of slots for the online scheduling of appointments. The template is a link between planning the service capacity at a tactical level and online scheduling at an operational level. We develop a detailed heuristic for the case of drug administration appointments in outpatient chemotherapy. However, the approach can be applied to online scheduling in other application areas as well. The desired scheduling principles are incorporated into the cost coefficients of the objective function of a binary integer program for booking appointments in the template, as requests arrive. The day and time of appointments are decided simultaneously, rather than sequentially, where optimal solutions may be eliminated from the search. The service that we consider in this paper is an example to show the versatility of a fixed template online scheduling model. It requires two types of resource, one of which is exclusively assigned for the whole appointment duration, and the other is shared among multiple appointments after setting up the service. There is high heterogeneity among appointments on a day of this service. The appointments may range from fifteen minutes to more than eight hours. A fixed template gives a pattern for the scheduling of possibly required steps before the service. Instead of maximizing the fill-rate of the template, the objective of our heuristic is to have high performance in multiple indicators pertaining to various stakeholders (patients, nurses, and the clinic). By simulation, we illustrate the performance of the fixed template model for the key indicators.

Discussion of cost continues to be uncommon in companion animal veterinary practice.

To determine the prevalence and nature of cost conversations occurring during veterinarian-client-patient interactions within companion animal practice. 60 randomly selected, practicing veterinarians working in 55 practices across southern Ontario, Canada, and 909 of their clients, sampled by convenience. A cross-sectional descriptive study including 917 video-recorded appointments. Associations between veterinarian, client, or appointment-level factors and occurrence of a cost conversation were evaluated using multi-level logistic regression. 215 of 917 (23.4%) videos included a discussion of cost between the veterinarian and client. Cost conversations involving veterinarians primarily focused on conveying the price in relation to the time or service being offered (74.0% [159/215]), whereas the benefit to the future health and wellness of the patient was conveyed in 14.4% (31/215) of veterinarians' cost conversations. Costs were most frequently discussed by veterinarians in relation to diagnostic testing (44.2% [96/215]). The odds of a cost discussion occurring were greater during problem appointments versus wellness (P = .011) or recheck (P = .029) appointments, for feline versus canine patients (P = .037), as appointment duration increased (P < .001), and as a client's number of visits in the past year decreased (P = .049). Discussing cost of care in veterinary practice continues to be relatively uncommon. Opportunities exist for veterinary professionals to frame their communication of the cost of veterinary care in relation to the benefits offered to the future health and wellbeing of the veterinary patient.

Increasing Workflow Efficiency in Urology Procedure Clinic

INTRODUCTION: Workflow inefficiency for urologic procedures leads to wasted time and workplace dissatisfaction, resulting in lost revenue due to low procedure volume and high staff turnover. We hypothesized that for staff (nurses/medical assistants) and patient teams, team workflow duration, the time required to complete team duties for a single appointment, could be reduced by 50% with a targeted workflow intervention developed using the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. METHODS: A baseline time study was performed to measure team workflow duration for all procedure appointment teams, including the front desk, physician, staff, and patient teams. Implementation of previously identified interventions was also recorded. A workflow intervention was developed in which staff duties were split among 2 overlapping roles: staffer and triager. Team workflow duration and intervention implementation were re-measured during 8 PDSA cycles. Semistructured 1-on-1 interviews were conducted as a balance measure to assess impact on staff workflow and wellness. RESULTS: Our workflow intervention resulted in a 44% and 42% reduction in staff and patient team workflow durations, saving nearly 17 minutes per appointment on average (Figure). Thematic analysis revealed that time saved would be best used to support staff wellness, such as protecting lunch breaks and allowing time to complete nonclinical duties such as patient calls, which had previously been performed after hours. CONCLUSION: Introduction of staffer and triager roles to staff workflow increased clinic efficiency by reducing team workflow and procedure appointment duration. Time saved can be used to increase procedure volume while also supporting staff wellness.Figure

84 Reducing appointment duration through monitoring clinic flow

84 Reducing appointment duration through monitoring clinic flow

Positive impact of the pandemic: the effect of post-COVID-19 virtual visit implementation on departmental efficiency and patient satisfaction in a quaternary care center.

The coronavirus disease 2019 (COVID-19) pandemic has significantly changed clinical practice across US healthcare. Increased adoption of telemedicine has emerged as an alternative to in-person contact for patient-physician interactions. The aim of this study was to analyze the impact of telemedicine on workflow and care delivery from January 2019 to December 2021 in a neurosurgical department at a quaternary care center. Prospectively captured data on clinic appointment utilization, duration, and outcomes were queried. Visits were divided into in-person visits and telemedicine appointments, categorized as follow-up visits of previously surgically treated patients, internal consultations, new patient visits, and early postoperative returns after surgery. Appointment volume was compared pre- and postpandemic using March 2020 as the pandemic onset. Clinical efficiency was measured by time to appointment, rate of on-time appointments, proportion of appointments resulting in surgical intervention (surgical yield), and patient-reported satisfaction, the latter measured as the proportion of patients indicating "high likelihood to recommend practice." A total of 54,562 visits occurred, most commonly for follow-up for previously operated patients (51.8%), internal new patient referrals (24.5%), and external new patient referrals (19.8%). Total visit volume was stable pre- to postpandemic (1521.3 vs 1512, p = 0.917). However, in-person visits significantly decreased (1517/month vs 1220/month, p < 0.001), with a nadir in April 2020, while telemedicine appointment utilization increased significantly (0.3% vs 19.1% of all visits). Telemedicine utilization remained stable throughout the 1st calendar year following the pandemic. Telemedicine appointments were associated with shorter time to appointment than in-person visits both before and after the pandemic onset (0-5 days from appointment request: 60% vs 33% vs 29.8%, p < 0.001). Patients had on-time appointments in 87% of telemedicine encounters. Notably, telemedicine appointments resulted in surgery in 31.8% of internal consultations or new patient visits, a significantly lower rate than that for in-person visits (51.8%). After the widespread integration of telemedicine, patient satisfaction for all visits was higher than before the pandemic onset (85.9% vs 88.5%, p = 0.027). Telemedicine use significantly increased following the pandemic onset, compensating for observed decreases in face-to-face visits. Utilization rates have remained stable, suggesting effective integration, and delays between referrals and appointments were lower than for in-person visits. Importantly, telemedicine integration was not associated with a decrease in overall patient satisfaction, although telemedicine appointments had a lower surgical yield. These data suggest that telemedicine smoothened the impact of the pandemic on clinical workflow and helped to maintain continuity and quality of outpatient care.

P252 Physiotherapy services in axial spondyloarthritis in the North West of England. An ASSIGNw benchmarking survey

Background/AimsThe physiotherapist's role in the assessment and management of axial spondyloarthritis (axSpA) is evolving. The axSpA Specialist Interest Group North-West (ASSIGNw) surveyed practices of its members in 2016. This abstract reports on a 5-year follow-up survey, exploring how our North-West physiotherapy axSpA services are running following the impact of the COVID-19 pandemic. The aim is to benchmark practice of physiotherapists working with axSpA, identifying discrepancies between services and recommending ways forward.MethodsIn June 2021, members of ASSIGNw identified areas of practice to benchmark; questions were formulated to elucidate these, creating a SmartSurveyTM sent to ASSIGNw members August-September 2021.ResultsSixteen Trusts replied, two more than the 2016 survey. Ratios of physiotherapy:medical staffing range from 1:1 to 1:8. All centres intended to offer virtual appointments as a long-term option. The majority of centres (60%) offered yearly follow up; 40% offered 6-monthly follow up. The median appointment duration had reduced from 45 minutes in 2016 to 30 minutes in 2021. The number of centres offering 60 minute slots reduced from 36% in 2016 to 20% in 2021. The vast majority of consults were undertaken independently by the physiotherapist (86%), a small number offering combined appointments with medical colleagues (7.1%). Half of centres surveyed had no access to onsite hydrotherapy, most of these actively signpost to local pools for self-led water-based exercise (62.5%). A dedicated flare/emergency access service was not offered by 60% of centres. Most centres undertake patient education on a one-to-one basis (94%); formal axSpA education programmes are only offered in one centre surveyed. P252 Table 1:Use of Outcome Measures in the Physiotherapy services of the ASSIGNw groupPaperElectronicMixture of paper and electronicBSR ePROMs platformMethod of collection of PROMs50%31%13%6%Outcome measures routinely collected% UseBASDAI94%BASMI94%BASFI81%Spinal Pain VAS75%Chest expansion69%Height69%Weight50%BMI31%Recent falls44%Walking aid use44%EASi-QoL13%Osteoporosis risk factors13%HAD scale score13%MSK-HQ6%FACIT-F6%HAQ-DI6%Patient-rated medication efficacy6%ASDAS0%PROM=Patient Reported Outcome Measure; ASSIGNw=Axial Spondyloarthritis Specialist Interest Group North-west; BSR=British Society of Rheumatology; ePROMs=electronic PROMs; BASDAI=Bath Ankylosing Spondylitis Disease Activity Index; BASMI=Bath Ankylosing Spondylitis Metrology Index; BASFI=Bath Ankylosing Spondylitis Functional Index; VAS=Visual Analogue Scale; BMI=Body Mass index; EASi-QoL=Evaluation of Ankylosing Spondylitis Quality of Life; HAD=Hospital Anxiety and Depression Scale; MSK-HQ=Versus Arthritis Musculoskeletal Health Questionnaire; FACIT-F=Functional Assessment of Chronic Illness Therapy-Fatigue; HAQ-DI=Health Assessment Questionnaire-Disability Index; ASDAS=Ankylosing Spondylitis Disease Activity Score.ConclusionThis survey, as in 2016, has highlighted a large inter-trust variation in physiotherapy:medic staffing ratio. A broad collection of outcome measures was collected and there is an unchanged general consensus that the BASMI and BASDAI are essential. The average and maximum appointment durations have both reduced. Urgent/flare and hydrotherapy access remains limited. Formal patient education is yet to be adopted, one-to-one education remains the prevalent model. Further work on standardising axSpA physiotherapy-led services is warranted. As we drive forwards best-care, the enhanced use of the full rheumatology multi-disciplinary team and standardisation of staffing levels is recommended.Disclosure W.J. Gregory: Honoraria; WG has received honoraria from Abbvie, Novartis, Pfizer and UCB. J. Brazendale: None. C. Greenall: None. G. McCall: None.

Feasibility of delivering and evaluating stratified care integrated with telehealth (‘Rapid Stratified Telehealth’) for patients with low back pain: protocol for a feasibility and pilot randomised controlled trial

IntroductionLong waiting time is an important barrier to accessing recommended care for low back pain (LBP) in Australia’s public health system. This study describes the protocol for a randomised controlled...

Outcomes of a virtual craniofacial clinic for assessing plagiocephaly during the COVID-19 pandemic.

The aim of this study was to carry out a quantitative analysis of a virtual craniofacial clinic during the COVID-19 pandemic. The charts of 90 patients from a single institution were reviewed. Of these patients, 45 visited the virtual clinic during the COVID-19 pandemic. The other 45 patients visited the clinic in the 3 months prior to COVID-19. Demographics including the mean age at the visit, chief complaint, visit diagnosis, appointment duration, helmet usage, accuracy of the diagnosis, need for a CT scan, and the need for a follow-up appointment were assessed. Diagnostic accuracy, the frequency of follow-up appointments, and patient satisfaction (via survey), as well as additional associated factors, were analyzed to determine the efficacy and satisfaction associated with the virtual clinic approach. The mean patient age at time of the visit was 5.6 and 7.3 months (p = 0.244), and the mean time from referral to appointment was 19.2 and 19 days (p = 0.934), in the in-person and virtual cohorts, respectively. There was no significant difference in the variety of chief complaints between the in-person and virtual visits, with 97.8% and 93.3% of patients' parents reporting abnormal head shape, respectively, and the remainder reporting more infrequent complaints (p = 0.435). The visit diagnosis was plagiocephaly in 93.3% of the in-person cohort and 80.0% of the virtual cohort (p = 0.118). The final diagnosis exhibited a similar pattern, with 95.6% of the in-person cohort and 88.9% of the virtual cohort observed as positional plagiocephaly; the remaining diagnoses were more infrequent (p = 0.434). The most common alternative diagnosis in the virtual visit cohort was a metopic ridge (8.4%). In the in-person visit cohort, the most common alternative diagnosis was equally a benign enlargement of the subarachnoid space in infancy, scalp mass, and skull lesion (2.2% each). None of the patients in either cohort were diagnosed with synostosis. Eighty percent of the in-person visits were 15 to 30 minutes in duration, with the remaining 20% being 31 minutes or longer; virtual visits were all 30 minutes or less, with 95.6% being 15 to 30 minutes (p = 0.002). Helmets were prescribed for 2 patients in the in-person cohort and no patients in the virtual cohort (p = 0.494). Alterations in diagnosis were made in 2.2% of in-person visits and 6.7% of virtual visits (p = 0.616). Follow-up was required in 15.6% of the in-person visits and 31.1% of the virtual visits (p = 0.134). CT was only utilized twice, once in the in-person visit cohort and once in the virtual visit cohort. Virtual clinic encounters resulted in comparable diagnostic accuracy. The trend toward frequent follow-up assessments and changes in the final diagnosis in the virtual clinic cohort has indicated a level of diagnostic uncertainty via the virtual interface, which required in-person assessment for confirmation. This finding did not contribute toward diagnostic inaccuracy with respect to missed synostosis. The study results have indicated that telemedicine can be an effective modality in assessing craniofacial pathology.

A Comprehensive, Multimodal, Interdisciplinary Approach to Chronic Non-Cancer Pain Management in a Family Medicine Clinic: A Retrospective Cohort Review.

The complexity of chronic non-cancer pain in the setting of regulatory efforts to curb opioid usage presents a novel challenge for the medical community. Much of this burden falls on primary care clinics. We retrospectively quantified the reduction of opioid usage by patients in a multimodal, interdisciplinary, primary care clinic for chronic pain. A multimodal, interdisciplinary, chronic pain clinic embedded in a large academic military family medicine clinic operated one-half day weekly to address referrals from within the clinic at large. Appointment times were longer than typical primary care appointments. The clinic was equipped with support staff, ancillary specialty providers, and non-pharmacologic complementary treatment resources. A retrospective cohort review was conducted on 78 patients referred to this clinic from March 1, 2015 (the inception date of the clinic) through December 31, 2015. Fifty-four of 78 patients met inclusion criteria. Overall mean morphine equivalent daily dosing (MEDD) dropped from 31.5 MEDD to 20.5 MEDD (p = 0.0005) 12 months post-intervention and from 31.5 MEDD to 9.5 MEDD (p < 0.0001) 36 months post-intervention. Four patients with a high mean baseline opioid dose of 185.2 MEDD dropped to 29.9 MEDD 36 months post-intervention. The mean 0-10 pain score decreased from 5.3 ± 2.2 to 4.0 ± 2.5 (p = 0.001). A multimodal, interdisciplinary, primary care-based, chronic pain clinic equipped with extended appointment times, non-pharmacologic treatment resources, and specialty access can curb opioid usage. Leadership support for protracted appointment duration, complementary treatment resources, and interdisciplinary personnel is crucial to success.