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Theme: Person-Centred Care
Follow-up appointments are routine for many patients, treated for a variety of conditions. Currently there is often a delay in holding these appointments due to pressure of clinical resources; something that is likely to be increasingly relevant with changes to the NHS.
The South West Strategic Health Authority’s initiative for improving healthcare in the Southwest (2008/9 to 2010/11) states that many follow-up appointments with out-patients are unnecessary. Patients who have had routine surgery, or those suffering with long-term conditions, such as thyroid disease or asthma, may benefit from telephone follow-up appointments.
Follow-up after surgical procedures is generally regarded as important for patient reassurance and for surgeons to audit efficacy and complications. Traditionally this has been by outpatient consultation with clinical examination. Telephone follow-up postoperatively might reduce the pressure on hospital services but whether this is acceptable to patients and whether important clinical problems which might be amenable to early intervention are missed is unclear. A review of existing literature in other specialties suggests that patients are receptive to the idea of telephone consultation, and are satisfied with the results of this approach.
Best practice is described as having a ‘no wait’ culture where all stages of care are delivered in a timeframe suitable for the needs of the patient, as opposed to at the convenience of the hospital or health organisation. In some cases, it may be that telephone appointments are suitable and preferable.
Our aim is to conduct a pilot trial within Plymouth Hospital NHS Trust to compare follow-up procedures (telephone and face to face) of patients who have undergone recent surgery for urogynaecological procedures (i.e. surgery for stress urinary incontinence and for pelvic organ prolapse reapirs).
The main objective of this pilot randomised controlled trial (RCT) was to inform the planning of the main RCT.
The aim of the larger RCT will be to assess the acceptability of follow-up by telephone versus traditional outpatient consultation after stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgeries.
If the trial proves that telephone consultations are a successful means of clinical follow-up, it will enable the practice to be used throughout the trust.
We hope to:
• Improve patient satisfaction by ensuring rapid follow-up and offering consultations that will be more convenient to them
• Improve cost-effectiveness
Ethical approval was granted from the NRES Committee London - Surrey Borders and recruitment began in May 2012.
Thirty five patients have been randomised; 18 to telephone follow-up and 17 to outpatient follow-up. Twenty-six patients declined to take part. Of these, 2 patients did not want follow-up at all, 7 requested telephone appointments as they felt they were more convenient and 17 requested outpatient appointments mainly due to on-going problems (n=9).
Patient reported symptom scores, achievement of goals and expectations and complication rates were recorded at follow-up. Patients were telephoned one week after their review by an independent researcher and a validated patient satisfaction questionnaire was completed (see below). Patients were also asked how reassured they were by having a clinical examination.
The RCGP patient satisfaction questionnaire was used in the trial and includes 11 questions such as: ‘Did the doctor/nurse make you feel at ease? (being friendly and warm towards you, treating you with respect; not cold or abrupt)’ and ‘Did the doctor/nurse fully understand your concerns? (communicating that he/she had accurately understood your concerns; not overlooking or dismissing anything)’. Patients answer ‘Poor to Fair’, ‘Fair’, ‘Fair to Good’, ‘Good’, ‘Very Good’, ‘Excellent’ or ‘Outstanding’ (range of scores from 1-7, with a maximum score of 77). Satisfaction scores were similar between the two groups (telephone = 56.8/77 and outpatient = 56.0/77). Eight patients in the telephone arm stated that they would not have been reassured by an examination; however, 14 of the patients in the outpatient arm were reassured by being examined.
A focus group is scheduled to take place at the end of January 2013. This is being facilitated by a member of PenPIG and will involve patients who have taken part in the trial. The aims of the group will be to obtain qualitative data on how the patients felt about taking part in the trial and if there is anything that we can do differently in the main RCT. Patients will also be asked in more details about their thoughts regarding each type of follow-up.