How Patient Initiated Follow-Up (PIFU) Improves NHS Patient Outcomes in Long-Term Conditions

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What is Patient Initiated Follow-Up (PIFU)? How does PIFU work?

The COVID-19 pandemic, having exacerbated the pre-existing problem around NHS waiting times, has led the NHS to increasingly prioritise new service models and in particular, Patient initiated follow-up (abbreviated to PIFU).

PIFU provides clinicians with an approach to helping their patients with long-term conditions gain a sense of power and confidence around the care that they receive by allowing them to manage their own follow-up appointments. Patients with long-term conditions do not necessarily need regular follow-up appointments, but rather appointments when they are unwell (for example, when they are experiencing a flare). 

If a clinician decides that patient initiated follow-up is right for their patient, they will put them on to a PIFU pathway, by mutual agreement between them and their patient. The patient will then be able to contact their team directly using different communication methods such as mobile apps, telephone and email in order to book an appointment when they need one. A clinician will inform their patient on the scenarios for which they should reach out for this type of appointment. The appointments that patients book can take place face-to-face, virtually or via telephone depending on the nature of what needs to be discussed. 

The Two Types of PIFU Pathways

There are typically two types of patient initiated follow-up pathways that a patient can be placed on. The first type is for patients who are effectively discharged to PIFU. These patients no longer have a future follow-up appointment scheduled but they are provided the option of being able to contact their service within a specific timeframe if they require care/if their condition status changes. The second type is where the usual schedule of follow-up appointments is pushed out i.e. a patient who may have previously been on 6 monthly reviews is moved to annual reviews, but if their condition changes or worsens before that date, they are able to make an appointment with their service/team.

Remote Monitoring within PIFU

Patient initiated follow-up is made even more effective when clinicians are able to remotely monitor how their patients are doing through tools such as mobile apps, where patients input and track their daily symptoms and details regarding how they are feeling. 

Ampersand Health’s My IBD Care and My Arthritis apps are both examples of mobile apps that offer this capability. If a clinician feels their patient is doing poorly, they can prompt them through the app to take different actions, such as come in for an appointment, book a specific test, or they may suggest digital therapeutics (like a course) to help them improve their self-management skills. Patients are also able to reach out through these apps if they would like to contact their clinician, creating a two-way communication process. 

For patients with long-term inflammatory conditions, such as IBD or arthritis, remote monitoring alongside PIFU is greatly beneficial for both the clinician and the patient. As these types of conditions often are defined by periods of remission and relapse, it is important that clinicians are able to help their patient identify triggers that cause them to experience flare, so that solutions can be created and disease remission can be more easily reached.  

What is the importance of PIFU?

More often than not, patients with long-term inflammatory conditions are scheduled to see their team at set intervals of time. As these appointments are not scheduled based on how the patient is doing, and more so to maintain a regular check-in cadence, patients can often end up being  seen when they are well rather than when they need to be seen the most. 

This leads to outcomes such as unnecessary appointments and an increase in A&E attendances and/or GP visits during periods of poor health. PIFU is key to improving patient outcomes while reducing costs for both the NHS and patients. There are many benefits to PIFU which demonstrate its importance, as outlined below. 

What are the benefits of PIFU for clinicians and patients?

The benefits of patient initiated follow-up include greater efficiency, more personalised care, reduction in waiting times, reduced costs, ‘always on’ digital access, and mutual empowerment. 

1. Greater Efficiency 

Although the term ‘efficiency’ is often seen as synonymous with ‘speed’, it actually refers to the ratio that exists between useful work that is produced, and the amount of energy that goes into that work. With patient initiated follow-up, the occurrence of unnecessary appointments is reduced, allowing clinicians to spend more time seeing patients who are unwell, leading to more meaningful outcomes and better quality of care, therefore creating a more efficient pathway. PIFU also allows patients to engage more with their clinician in their appointments and therefore become more involved in their own care, which leads to better outcomes and a greater sense of confidence in one’s ability to manage one’s own care.

2. Personalised Care

The NHS strives to deliver personalised care, meaning patients have more choice and control over the way their care is planned and delivered. Patient initiated follow-up  allows patients to communicate their needs, concerns and thoughts more effectively and in a timely manner, allowing their clinician(s) to gain better insight into what they are experiencing between appointments. This helps the clinician provide more personalised, impactful and thoughtful care to their patient(s). 

3. Reduction in Waiting Times 

As less unnecessary appointments take place, clinicians have more time to see patients who are truly unwell, in a more timely manner. This reduces the amount of time that patients need to wait to see their clinician, allowing them to be seen when they need it the most and not only when they have passed through a difficult time already. A clinician is then able to provide the most impactful care, as the appointment will be more useful and needed. It can take weeks, sometimes months to see your clinician. At the time of writing, the average waiting time to see a consultant within gastroenterology in England was 13.2 weeks, 11.4 weeks for rheumatology  (NHS Waiting List Tracker). Having this reduction in waiting times for patients is a huge benefit to their health outcomes. 

4. Reduced Costs

There are many costs associated with NHS appointments, for both the patient and the NHS. For the patient, there is the cost both financial and environmental of travel to and from appointments, which can be quite high if one’s hospital is far away from where they reside. Also, if a patient has to miss work to attend an appointment, employers are impacted. These costs vary from patient to patient, however when unnecessary appointments occur, any cost for the patient could be deemed excessive. For the NHS, there is the cost of that appointment itself alongside administration costs. As sometimes these unnecessary appointments may be missed, the cost of a missed appointment (DNA) is also a wasted cost by the NHS. Overall, having appointments only occur when they are necessary and wanted by the patient is a cost-saving strategy to follow. 

5. ‘Always on’ Digital Access

Even before the COVID-19 pandemic, the world of healthcare was slowly shifting towards implementing more digital methods of care. As patients are able to digitally communicate with their clinical teams about their condition, symptoms and other needs, these interactions occur quickly and in real-time. Through remote monitoring tools for individuals with long-term conditions, for example, Ampersand Health’s My IBD Care and My Arthritis app, clinicians can view the data that patients input into the app and decide if further action is needed in their care, or if they are doing well and no further action is required. 

6. Mutual Empowerment

PIFU provides patients with the opportunity to take their health into their own hands. This leads to a sense of empowerment for patients, that they are not only the key player in their healthcare journey as their engagement improves and increases, but that their relationship with their clinician is stronger as well. Additionally, clinicians are able to feel more empowered in their own role, as they provide care to their patients with more confidence. 

Patient initiated follow-up is key to creating a stronger system within the NHS. It is important that patients feel increasingly involved in their care, and in turn, clinicians will feel better about the care that they can provide them. Aside from the personal benefits of PIFU for patients and clinicians, overall it will reduce costs for the NHS and create a more sustainable, effective, efficient and impactful healthcare system within the UK. 

Ampersand Health’s My IBD Care and My Arthritis apps have been implemented in various Trusts across the NHS. To learn more about how our apps help with remote monitoring and play a role in the PIFU pathway, reach out to us today at info@ampersandhealth.co.uk

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