Telephone Clinic Research Articles

269 (PB-093) Poster - The utility of virtual clinics in the assessment of patients with mastalgia: a model for breast services post-pandemic?

Background: Mastalgia is a common breast symptom amongst patients, which often prompts referral to breast services. Despite the lack of correlation between mastalgia alone and breast cancer, patients referred to breast clinic with this symptom often report significant anxiety around their visit, due to the worry of a cancer diagnosis. This can be the case as these patients are often seen in a one-stop breast clinic alongside other women with symptoms that are more concerning for breast cancer. We developed a virtual telephone clinic (VTV) to assess patients with mastalgia, outside the one-stop rapid access breast clinic, and assessed the clinics safety and validity in managing this group of patients.

205 DESIGN OF AN AMBULATORY CARE HUB IN AN OLDER PERSONS SETTING

Abstract Background The service was established to deliver rehabilitation based in a day care setting. The Multi-Disciplinary Team (MDT) allocated to cover the unit often had other clinical responsibilities. Therapy was delivered in silo with differing plans/goals for individual patients. There was often reduced with insufficient/no cover to the department. The department was closed during the pandemic. Upon reopening a decision was made to restructure service delivery. A pathway of change was decided on to move from a day care setting to an ambulatory hub model of care. Methods A Delphi method was undertaken and a review of processes conducted by the Clinical Nurse Manager 2 (CNM2). Consequently, all new referrals were screened and virtual telephone clinics held. Nursing Comprehensive Geriatric Assessments (CGA) were conducted on patients referred by their GP or who had not attended the Age-Related Healthcare Department within 6 months. This ensured clarity around patient needs. Individualised care plans were initiated before the patient’s medical appointment took place. Any urgent reviews were flagged to specific therapists by the CNM2. Results The service was restructured and is now interdisciplinary in approach. The Service moved from a day care setting reviewing approx. 60 patients weekly to an ambulatory care hub model with over 450 targeted interdisciplinary reviews weekly. A spreadsheet was developed and collated weekly by the CNM2 informing therapists of referrals received hence streamlining care- planning. This enabled MDT collaboration and merging of appointments to prevent multiple attendances. This development has been welcomed by patients and families. Conclusion The Ambulatory Care Hub operates at a maximum capacity with patient’s receiving targeted comprehensive interdisciplinary therapy input. There is a greater sense of teamwork within the department and patients benefit from this collaboration. This redesign has shown that a well-structured MDT provides essential support in many areas of disease management.

Telephone triage for 2-week-wait cancer clinics: a viable alternative to face-to-face clinics?

Head and neck cancer services have had to adapt to reduce the risk of exposure to patients and staff during the pandemic. Telephone consultations as a first point contact have been adopted in some centres. It is important that this does not lead to delays in diagnosis. Our hospital adopted a telephone triage service and we aim to describe the implications of this structure. Data were collected from all new patients referred to the head and neck 2-week-wait (2ww) pathway from June to September of 2019 and 2020. Days between first clinic appointment and cancer or noncancer diagnosis were calculated. Statistical tests were performed between years. A total of 215 patients in 2019, and 165 in 2020 were included; 23 (6.8%) cancer diagnoses were identified across 2019 and 2020 groups. The cancer group had a mean time from first consultation to date of diagnosis of 16.33 days in 2019 and 12.81 days in 2020. There was no significant difference in days until diagnosis between 2019 and 2020 (p=0.05). In the noncancer group there was no significant difference in days until noncancer diagnosis (p=0.05). In 2020 26.1% (n=43) patients did not need to be seen face-to-face (f2f) under the 2ww pathway after telephone triage. No difference in diagnosis timing was observed between cancer and noncancer patents in 2019 and 2020. Telephone clinics reduce the total number of f2f appointments required. Reduction in the number of f2f appointments may have other benefits in saving time and environmental costs.

Do patients prefer face-to-face or telephone consultations in an outpatient cardiology department?

Abstract Introduction There has been a significant rise in the telephone clinic consultations in preference to face-to-face (FTF) clinics in the UK during the COVID 19 pandemic. The cardiology department in a district general hospital has also seen increased use of telephone clinics. We wanted a greater understanding of the impact of telephone consultations on patient satisfaction. Methods A patient satisfaction survey was designed based on the joint Royal College of Physicians training board (JRCPTB) patient satisfaction survey. The survey (Image 1) was sent via post to 300 patients reviewed by the cardiology outpatient department during November 2021. 150 who had telephone appointments and to 150 patients who had FTF appointments. Descriptive statistics and student T test were used to compare differences between the two groups with a p value of <0.05. Results There were 171 responses returned over a four-week period giving a 57% response rate. Of these, 75 respondents had a telephone appointment and 96 who had FTF appointments. 49% of the FTF patients were male compared to 55% of the telephone clinic respondents. The majority of patients were aged 70–89 in both groups and most patients were retired (79.2% for FTF and 65.3% on the telephone consultation group). More patients felt the doctor was polite and considerate in FTF clinics compared to telephone consultation (97% compared to 92% positive responses, p value – 0.02). There was no significant difference in patients feeling listened too, being allowed time to ask questions, understanding their condition and being involved in decision making between the two groups (Table 1). Of the FTF group, 81% preferred FTF clinics with only 3% preferring telephone clinics and 16% with no preference. Of the telephone group 53% stated a preference for FTF clinics, with 11% having a preference for phone clinics and 36% having no preference. Patients rated overall experience more positively with FTF appointments (95%) compared to telephone clinics (85%, p value 0.02). Conclusion Telephone consultations performed at a comparable level to FTF clinics although patients demonstrate an overall preference for FTF clinics. Funding Acknowledgement Type of funding sources: None.

Analysis of a Single Centre's Protocol of the Treatment of 5th Metatarsal Fractures. What Patients Need a Face-To-Face Fracture Clinic Review?

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: 5th metatarsal fractures are a common injury attending foot and ankle clinics in the UK. Within our department, we established a protocol to reduce the burden on fracture clinic of 5th metatarsal fractures by limiting face-to-face consultations to Zone 2 and 3. We sought to investigate whether our practice was consistent and the ultimate patient destination. Methods: Patients were identified from our database. We included all 5th metatarsal fractures referred to our virtual fracture clinic with a confirmed 5th metatarsal fracture. Data was collected on virtual fracture clinic (VFC) outcomes including telephone review, clinic reviews and requirement of surgery. Plain AP radiographs were reviewed for fracture morphology. Fractures were defined as Zone 1.1, 1.2, 1.3, 2, 3, diaphyseal shaft (DS), distal metaphysis (DM) and head. A binary linear regression analysis model was used. All data was analysed using IBM SPSS v.27. Results: 1360 patients met the inclusion criteria (mean age of 48.1; range 16-95, sd=19.1). 430 (31.6%) were planned for face-to- face review, however following telephone review, 542 (39.9%) were sent appointments (p<.001 McNemar). On univariate analysis, only fractures in Zone 1.1 were associated with a plan to discharge from VFC (OR 2.851, p<.001), with Zone 3 fractures associated with a plan for face-face review (p<.001). Following telephone review, Zone 2 (OR 1.387, p=.034) and Zone 3 (OR 3.285, p<.001) fractures were the only fractures significantly associated attending a face-to-face clinic appointment, with Zones 1.1 (OR 0.573, p=.008) and 1.2 (OR 0.642, p=.033) negatively associated. Zone 3 fractures were the only fractures that retained significance for attending >1 appointment (OR 4.639, p>.001) and requiring surgery (OR 3.895, p=.037). Only 15 patients (1.1%) required surgery, with 9 being for non-union and 5 being acute operations in younger patients (median age = 34 vs 51). Conclusion: There was a significant increase in patients requiring face-face review after telephone conversation. In addition to Zone 3 injuries and Zone 2 injuries had also required face-face reviews following telephone consultation. Based on these results, all Zone 2 and 3 fractures should be considered for at least one face-to-face fracture clinic review. Operative management is rare and usually secondary to non-union.

Satisfaction with telemedicine-delivered inflammatory bowel disease care depends on disease activity, personality and economic factors

ObjectivePatients with inflammatory bowel disease (IBD) traditionally receive follow-up care at face-to-face outpatient clinics. During the COVID-19 pandemic, gastroenterology societies recommended IBD clinics to be carried out remotely where possible...

A retrospective cohort study of telephone versus face-to-face clinics for the management of new otology referrals.

PurposeTo compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology.MethodsRetrospective cohort study including new adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, seen in either a face-to-face or telephone clinic. Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review.Results150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (χ2 < 0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts, respectively (p < 0.001).ConclusionsTelephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem; however, further research is required.

O5-7 Feasibility Study- A physiotherapy led remote ACHD Cardiac Rehabiliation Program

ProblemPrevalence of adult congenital heart disease (ACHD) is growing. Exercise is safe and effective at enhancing exercise capacity and quality of life (QOL) for ACHD patients but they are predominately sedentary with reduced exercise capacity and obese compared to peers. ACHD patients are concerned about their inactivity, however are uncertain of exercise suitability and safety and are unable to access specialist advice or cardiac rehabilitation (CR). Many ACHD patients are managed in specialist centres covering vast areas meaning classes are inappropriate. Acquired heart disease CR is cost-effective, improving QOL, exercise capacity, mortality and morbidity. ACHD patients potentially gain the same benefits. Remote cardiac rehabilitation (RCR) using technology could be a feasible model providing accessible specialist knowledge and individualised exercise prescription.Description of the problemCardiologists referred sedentary, complex ACHD patients for a 12-week RCR providing individualised exercise prescription, education and motivation via telephone clinics and free apps (PT Momentum, Pacer and Active 10). Initially, habitual exercise was encouraged, participants were coached to achieve the recommended UK PA guidelines. Self-efficacy for Exercise (SEE) and Satisfaction with Life Score (SWLS) were assessed comparing patients' responses upon program completion to baseline. To determine the feasibility and acceptability of RCR to ACHD patients and quanitfy the impact of RCR on patient's physical activity (PA) and QOL.To discover if technology supported programme can increase the PA level of ACHD patients.ResultsFrom 23 referrals, 11 completed the program becoming more physically active, fulfilling the guidelines. Improvements were seen in both SEE (mean 30) and SWLS (mean 10). Patients deemed RCR an acceptable service delivery.Participants (9) responded well to apps. Reasons for not using apps included data capacity (1) or no device (2).LessonsACHD patients engaged with RCR making it; viable, acceptable and practical solution improving PA levels and QOL.RCR using app's is a feasible model however, alternatives are required.Main MessagesRCR enables ACHD patients to receive specialist knowledge, individualised, accessible and effective exercise prescription improving QOL and PA levels.RCR potentially leads to substantial cost savings and improvements in morbidity and mortality of ACHD patients.

Digital Communication Between Patients and Health Care Professionals Across Disciplines and Sectors After Hospital Discharge: Facilitators, Barriers, and Effects

Background Over the past decade, hospital admissions for patients undergoing orthopedic surgery have been shortened, and the time for informing and educating patients prior to discharge has been compromised. The transition of care from hospital to home poses a substantial risk of adverse events. Patients have difficulty remembering information and struggle to assess the severity of symptoms after discharge, leading to unplanned telephone contacts and clinic visits. These inquiries are frequent and pose a substantial burden on the health care system and patients. The COVID-19 pandemic showed an emerging need to implement new communication technologies. Asynchronous digital communication (DC) may provide easy access to health care and seamless communication across sectors. Objective This study aimed to investigate how DC can facilitate easy communication between patients and health care professionals (HCPs) across sectors and the effects of DC on patient-initiated telephone contacts after discharge. Methods The overall theoretical approach was inspired by Continuity of Care and the Consolidated Framework for Implementation Research. Substudy I was a scoping review on DC between patients and HCPs after hospital discharge. Substudy II explored DC in an orthopedic surgery setting and through a triangulation of qualitative data collection techniques. Substudy III investigated the effect of DC on patient-initiated telephone contacts after discharge. Results Preliminary findings from substudy I show that DC is increasingly used to support patient-provider communication after discharge. In substudy II, preliminary findings show that DC is feasible in a real-life setting, providing patients with easy access to HCPs, who accept and adapt DC to existing cross-sectoral workflows. However, barriers exist related to the technological integration between systems and individuals’ hesitation to use DC. In substudy III, DC is to be tested in a randomized controlled trial. Conclusions This study generates new knowledge of asynchronous DC that may guide future implementations across the health care system.

326 Is Patient Satisfaction Affected by Replacing Face-to-Face Appointments with Telephone Assessments for Balance Complaints?

Abstract Aim It was found that 91% of surgeons conducted virtual consultations during COVID-19 pandemic. In March 2020, ENT UK recommended that telephone review should be the first approach for all outpatients who do not need urgent treatment. Dizziness diagnoses may be made primarily from the medical history, making telephone clinics suitable. This study aims are to determine the level of patient satisfaction with telephone consultations for balance complaints. Method The electronic patient records of ENT patients were reviewed retrospectively to identify all adult patients with first presentation of dizziness between October 2020 and May 2021.Patients were contacted by telephone and completed the short form patient satisfaction questionnaire (PQS-18). The statistical software SPSS was used for analysis. Results 26 out of 37 patients contacted were reached successfully giving a response rate of 70%. There were 12 patients in the telephone consultation group and 14 patients in the face-to-face group. Average general satisfaction and satisfaction with technical quality were lower in the telephone consultation group (p-values of 0.012 and 0.007 respectively). Total average score was also lower in telephone consultation group with p-value of 0.028. 91% of patients who had initial assessment by telephone needed a follow up face to face consultation as opposed to only 14% in the face-to-face group. Conclusion Patients were less satisfied with primary assessment of balance complaints by telephone. Most of these patients required face-to-face follow up consultations.

746 A Novel Method of Remotely Managing Complex HHT Patients via Telephone Clinic to Reduce Severity and Frequency of Nosebleeds

Abstract Introduction Hereditary haemorrhagic telangiectasia (HHT) is a complex, multisystemic vascular dysplasia affecting approximately 85,000 European Citizens. Patients who have hereditary haemorrhagic telangiectasia can have severe debilitating manifestation of symptoms which can severely affect their quality of life. One of the severe manifestations is epistaxis, this can often lead to being anaemic, needing blood transfusion and hospital admission. Method Patient data was analysed to record number of hospital visits, A&amp;E attendances, and hospital admissions. Multidisciplinary approach to involve various teams including but not limited to specialist nurses and clinicians. Results Virtual clinics facilitate management of HHT patients with complex needs. Provision of (nurse led) specialist virtual clinic in the form of telephone consults giving advice regarding maintenance and emergency care in case of a nosebleeds. This facilitates safe pathway for emergent care and avoids hospital visit with every episode. The patients are provided with an emergency pack and a prevention pack. The emergency pack contains nasal packs, tranexamic acid mouthwash 5%, nasopore, kaltostat whereas the prevention pack contains triple therapy. Analysis of patient data suggests reduced number of hospital visits, A&amp;E attendances, and hospital admissions to seek specialist treatment. Conclusions Virtual clinics are an upcoming novel method of managing complex patients. They are beneficial for patients allowing them specialist access to medical advice to manage their symptoms at home. Improved patient care pathway allowing easy access of specialist medical advice. Safer management of complex HHT patients reducing frequent hospital visits for reasons like consultations, blood tests, admissions, and blood transfusion.

WE8.9 Do Telephone Clinics Lead to Greater Patient Satisfaction in General Surgical Outpatients?

AimsTo limit exposure risk in view of the current COVID-19 pandemic, telephone clinics have become the mainstay of outpatient assessment. Although there is data from primary care, there is little evidence for the suitability of telemedicine within General Surgery. The lack of clinical examination can be dissatisfying for both patient and surgeon. The aim of this study was to explore patient satisfaction from telephone clinics in a General Surgery setting.MethodsData was collected prospectively from general surgery clinic appointments by a single surgeon in a District General Hospital from September 2021. Demographic data was obtained in addition to a short questionnaire at the end of their consultation. Patients were asked to score their experience out of 5 (5 being most favourable) and their preference in comparison to face to face appointments.Results156 patients were included in the study, of which 95% of patients were contactable. 98% of patients gave the experience a satisfaction score of 3 or more out of 5. The median satisfaction score was 5. 97% expressed a preference over a Face-to-Face appointment. 7% of patients required a further Face-to-Face consultation and this group were more likely to have a lower patient satisfaction score.ConclusionTelephone clinics within general surgery achieve excellent satisfaction for the majority of patients. The patient experience could be further optimised by careful selection of patient suitability for the service. The data provides supportive evidence to the NHS Long Term Plan to reduce Face-to Face outpatient appointments by one third before 2024.

WE8.7 Are Virtual Clinics for General Surgery Here to Stay? – A Single Centre Analysis

AimVirtual clinics were rapidly established during the COVID-19 pandemic to maintain outpatient surgical care.To evaluate their use, we analysed telephone clinic outcomes and their compliance with the NHS Referral to Treatment (RTT) guidelines.MethodData was collected for patients booked into Upper GI Surgery clinics between September – December 2020 (n = 622). This included details of referral, appointments (first to most recent), patient attendance, and clinic outcomes (active monitoring, offered surgery, discharge, other). We compared first appointment management decisions between telephone and face-to-face clinics.Results317 patients had their first appointment via telephone; 179 patients were seen initially face-to-face.For first appointments, non-attendance rate was 9.8% (31/317) in telephone clinics versus 3.9% (7/181) in face-to-face clinics.At first appointment, 8.5% (27/317) of patients consulted via telephone were offered surgery compared to 20.1% (36/179) seen face-to-face.22.4% (71/317) of telephone clinic patients were started on active monitoring at first appointment, compared to 31.3% (56/179) of patients assessed face-to-face.31.3% (155/496) of all patients analysed were compliant with RTT guidelines – 57.4% initiated on active monitoring; 11.6% underwent surgery.ConclusionPatients are less likely to be listed for surgery after their first assessment if this was via telephone appointment compared to face-to-face. Delays in physical examination, and clinician and/or patient hesitancy may contribute to this; higher non-attendance rates would further postpone outcomes. However, telemedicine does allow effective active monitoring.To better evaluate telemedicine's efficacy in sustaining timely patient care, comparison of compliance with the RTT guidelines for cases managed solely face-to-face pre-COVID-19 is warranted.

WE8.5 Can self-estimated BMI be used for pre-operative planning in elective general surgery?

AimsTelemedicine is being increasingly used in outpatient settings following the COVID-19 pandemic. This study aimed to determine if self-estimated body mass index (BMI), from telephone consultation, was accurate and useful for planning prior to elective general surgery.MethodsAge, gender and estimated BMI were collected from consecutive patients attending a pre-operative telephone clinic under a single surgeon at a district general hospital in the South of England between April and October 2021. Actual BMI was measured on the day of surgery and compared.Results124 patients were included (median age 59 years, 49.2% male). BMI was accurately estimated by 38, under-estimated by 33 and over-estimated by 53 participants. Overall, there was a significant difference in the pre-operative and post-operative BMI (p = 0.003). This was significant for females (median change 0.1, IQR 0.0–0.7, p = 0.002) but not for males (median change 0.0, IQR -0.1, 0.2, p = 0.479). Those with an actual BMI >29.9 had a significantly higher median change (0.2 (0.0, 1.1) compared to those with BMI ≤29.9 (0.0 (-0.2, 0.1); p <0.001). Only 2 patients could have required a change in surgeon on the day of the procedure (p = 0.500).ConclusionsSelf-estimated BMI is a suitable method for assessing patients for planning in elective general surgical procedures, particularly for males. However, it is important to be aware of those with higher BMIs, particularly females, who may underestimate their BMI.

A nurse led telephone clinic is a safe and effective service for assessment of patients with breast pain

Introduction: Breast pain as an isolated symptom, with a normal clinical examination, is rarely associated with sinister pathology. In our service we manage these patients out with the one stop clinic (OSC), as most do not require breast imaging and / or biopsy. COVID19 has forced reduction in face-to-face outpatient appointments. We developed an advanced nurse practitioner-led telephone clinic (TC) to manage patients referred with breast pain. Here we describe the outcomes of this service.

Patient satisfaction with general surgery telephone consultations during the COVID-19 pandemic: a single surgeon experience.

COVID-19 pandemic accelerated the development and use of telemedicine in surgical practice. Here we set out to understand patient satisfaction with the use of telephone consultation in the general surgical clinic and preference over face-to-face consultation. A prospective cohort study was carried out for consecutive patients seen in a general surgery telephone clinic by a single surgeon in a district general hospital in the UK from 1st September 2021 to 10th March 2022. Demographic data was collected from electronic patient records. At the end of the consultation patients were asked to: 1) score their satisfaction with the telephone consultation on a 5-point Likert Scale; and 2) whether they preferred telephone consultations to face-to-face appointments. It was noted if a patient required a further face-to-face consultation in addition to the telephone consultation. The study included 245 patients who were reviewed by telephone consultation. Most patients (59.6%; N.=146) gave the telephone consultation the highest satisfaction score with a further 31% (N.=76) scoring it as a 4 out of 5. Only 2.8% of patients said they would have preferred a face-to-face consultation and gave a median satisfaction score of 2 (IQR 2-3) compared to 5 (IQR 4-5) in those who preferred telephone consultations (P<0.001). Telemedicine is associated with high levels of patient satisfaction regardless of patient age or gender. Lower rates of satisfaction are associated with the need for further face-to-face follow-up. If telemedicine is to remain a permanent part of surgical practice, disease specific protocols for its use are required.

Implementation of a telemedicine service to provide skin cancer care in a tertiary plastic surgery unit during COVID-19 – a comprehensive review

BackgroundIn response to the COVID-19 pandemic, our tertiary skin cancer service had to adapt rapidly to reduce hospital footfall. Consequently, all clinic appointments for skin cancer patients were converted to telephone consultations. This study aims to provide a comprehensive review of this new service.MethodsThis study consisted of three domains: patient and staff experience, efficacy and productivity. Patient and staff experience was assessed through prospective surveys.Efficacy of telephone appointments was assessed through prospective review of clinic coding to evaluate outcomes including rate of conversion to face-to-face appointment. Markers of treatment pathway efficacy included time from referral to surgical listing and the incidence of benign lesions placed on skin cancer pathways.Productivity was evaluated through review of the cumulative number of completed and missed appointments over a 1-month period before and during the pandemic.ResultsAll patients were satisfied with the telephone consultation and were preferred to previous experience of face-to-face appointments by 67%. Over 80% of responding clinicians felt telephone clinics should remain as a legacy of COVID-19.Time from referral to scheduling for surgery was significantly shorter for urgent lesions when listed through a teleclinic compared to face-to-face appointment. The telephone service allowed us to maintain 46% of the plastic surgery outpatient activity of May 2019 and missed appointments almost halved.ConclusionPatients and clinicians have responded positively to the new service. This study highlights the merits of an ongoing telephone clinic service for select patients on resolution of the COVID-19 impact on health services.

P130 Pharmacist-led osteoporosis telephone service

Background/AimsThe COVID-19 pandemic has made finding ways to consult suitable patients remotely a priority. We have introduced a telephone assessment clinic, run by our departmental pharmacist, to assess and treat patients with osteoporosis who have been referred from primary care for consideration of parenteral bone sparing therapy.MethodsPatients with osteoporosis who have been referred from primary care were triaged electronically into a fortnightly telephone assessment clinic, according to pre-specified criteria. Prior to the appointment, information leaflets about osteoporosis, and treatments for this condition were posted to the patients. The telephone consultation was carried out and patient demographics, risk factors for fracture, bone density results, FRAX / NOGG assessment, treatment decisions, and other clinical details were recorded on a pro-forma. A satisfaction survey was sent out to each patient following consultation.ResultsSixty patients were assessed between July 2020 and April 2021. Fifty-seven (95%) were female, and the mean age was 71 years. Following consultation, twenty-one were commenced on zoledronic acid, eighteen on denosumab, three on teriparatide and eighteen no treatments /other. Average time from referral to consultation was 1.75 months. Thirty-four patient satisfaction surveys were returned. Twenty-nine (85%) patients said they would be happy for consultations via telephone in the future, with twenty-five patients (74%) either likely or highly likely to recommend telephone consultation to family or friends. When asked to compare their experience of telephone to face-to-face consultations; twenty (58%) reported being indifferent, four (12%) said their experience was poorer or significantly poorer than face-to-face, and ten (29%) said their experience was better or significantly better. Mean saving on travel expenses was £0-£5 (41% of patients) with four patients (12%) saving £21+. Mean mileage saved was < 5 miles (33% of patients), with seven patients (21%) saving 30+ miles on travel.ConclusionThis study reveals that patients, overall, had a positive experience with a pharmacist-led telephone consultation. Such clinics could be implemented across other areas of our rheumatology service, if clinically appropriate; reducing unnecessary patient contact, reducing consultant work load and optimally utilizing skills of the wider multi-disciplinary team. Face-to-face consultations still have an essential role where physical examination may be required, or patients have communication barriers. Our sample size was small, and data collection is on-going.Disclosure N. Rusby: None. M. Bridges: None.

P004 A quality improvement project at Bradford Teaching Foundations Hospital to reduce high-cost medication waste and improve medicines optimisation

Abstract Background/Aims Biologics and methotrexate are high-cost medications delivered to patients through pharmacy homecare services prescribed and dispensed at 8-weekly intervals in our Trust. It is estimated nationally, £300 million of NHS prescribed medicines are wasted annually. The aim of this quality improvement project (QiP) was to investigate the extent and reasons for high-cost medication waste within the rheumatology department at BTHFT and develop a service to overcome these issues thereby improving medicine optimisation and reducing waste. Methods Homecare data was reviewed over 12 months from Jan 2020- 21 looking at high-cost medication waste within rheumatology at BTHFT. Two hundred and sixty-seven rheumatology patients were initiated on therapy in this period. Forty-four (16%) patients stopped therapy within a year of initiation. Of the 44 patients, 32 patients stopped within their first 8-week delivery resulting in £17,362 in wastage of medications. On further analysis, reasons for treatment cessation included: adverse effects, non-adherence due to lack of response or patient choice, lack of information and change in treatment plan by overseeing consultant. To overcome some of these issues we changed initial prescribing methods and dispensed 4 weeks supply of medication. We set up a pilot pharmacy telephone clinic between 9th April and 18th June 2021. Patients were phoned 8 weeks after nurse counselling when patients should have been 3 weeks into treatment with their new biologic and provided with further information and reassurance. Any clinical queries outside the pharmacist’s remit were directed to the rheumatology team. If patients were continuing medications, a further appropriate length prescription was dispensed. Results Over the 10-week period of the pilot study, 83 new patients started on therapy, 46 of these were provided with reassurance/support and of those, 9 held/stopped treatment. Through the pharmacy support line, £2,612 of medication cost was saved as these patients had received 4 weeks of medication rather than the usual 8 weeks supply. This translates to approximately a potential of £13,500 of medication waste which can be saved annually through reduced initial prescription of biologics together with implementation of a pharmacy support line through the rheumatology department alone. Another unexpected benefit of the pharmacy support line was improved compliance and adherence to treatment through further counselling and guidance that was delivered to patients who may have stopped treatment without the additional support provided by the pharmacist. Conclusion The introduction of a pharmacy-led telephone support service together with a change in prescribing practice can reduce waste, save money and improve patient outcomes through medicine optimisation. This service could be rolled out to other specialties using high-cost medication with similar intended benefits. Enhancing roles of pharmacists in this way will help meet increasing demand and improve services for patient as recommended by the recent rheumatology GIRFT review. Disclosure P. Sidhu: None. G. Quinn: None. K. Nadesalingam: None.

P155 Implementing change in treatment delivery for children and young people during a pandemic

Abstract Background/Aims The Paediatric Rheumatology Team at the Great North Children’s Hospital (GNCH) provides care to children and young people (CYP) across the northern region. On average 70 new CYP are diagnosed annually with rheumatic conditions. Approximately 1/3 will require long-term treatments and long-term rheumatology follow-up. The team support over 300 patients receiving treatments for at home, with 75 CYP requiring regular treatments administered in hospital. Tocilizumab targets IL-6 and is used to treat rheumatic conditions. Tocilizumab, approved for use in children with certain subtypes of JIA in 2011, is normally administered via an intravenous infusion on the Paediatric Day Unit, at GNCH. The procedure takes approximately 3 hours and involves a cannula for administration. Part of Continuity and Emergency Planning for the COVID- 19 pandemic the Medicines &amp; Healthcare Products Regulatory Agency (MHRA) compiled a list in April 2020 of medications including tocilizumab, not to be exported from the UK or hoarded. Tocilizumab was a proposed treatment for hyper-inflammatory response for COVID-19 and concern that supplies would be affected. NHS hospitals were advised to reduce routine activity and footfall through the hospital. The team agreed the need to consider alternative treatment delivery. Methods A patient cohort were identified attending GNCH for intravenous infusions. 38/65 (58%) patients were receiving tocilizumab. The pharmacist agreed to switch CYP from intravenous to subcutaneous tocilizumab. A total of 34 eligible patients were identified (32/38 current patients and two new patients) Using a multi-disciplinary approach, the pharmacist established agreement, arranged supply and delivery of medication to the families. The CNS contacted all families via nurse-led telephone clinic and invited eligible CYP to a face-to-face clinic, to received counselling and training to administer. The rheumatology consultants supported the change with prescription management. Over a 6-week period all eligible CYP transferred to subcutaneous form of tocilizumab administered at home. Medication was transported to families via home care delivery company. Results 34 patients switched, 9/34(26%) reported localised injection-site reactions, varying in severity but could lead to discontinuation of treatment. An inconsistent approach to managing these reactions was recognised by the pharmacist and CNS. Collaboration with the paediatric allergy teams, devised a standardised approach to manage injection-site reactions using an algorithm. Conclusion • Reduce pressure on precious hospital resources • More convenient for families - minimise long distance travel for treatment and time off school/ work • True collaboration and recognition of multidisciplinary team working swiftly to find a solution to a problem impacting upon patients, their family and the Trust • Algorithm devised by the paediatric pharmacist using easily accessible oral and topical treatments for families to use at home to manage site reactions. • Tocilizumab has proven to be useful in treatment of critically unwell patients infected with COVID-19. Disclosure R. Wyllie: None.