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Introduction and objectivesMissed clinic appointments are a huge financial burden on the NHS, with an average of 6.9 million outpatient appointments being missed each year.1 The difficult asthma clinic at our inner city hospital is no exception to this trend. Many factors are likely to contribute to missed appointments, which can be summarised in with in socioeconomic deprivation indices. We wanted to confirm whether there is an association between missed appointments and socio-economic deprivation. We hypothesised that non-attenders lived in areas with worse deprivation scores.MethodWe compared deprivation scores of English postcodes of clinic attenders and non-attenders of a ‘difficult asthma clinic’ between 2011–2014 inclusive. Indices of multiple deprivation scores were using census related data and Townsend Index via UK data service ©University of Essex and University of Manchester. This provides a validated, relative measure of deprivation across small localities in England to enable comparison. A higher score represents an area with worse socio-economic deprivation, maximum score = 100. Mann-Whitney two-tailed tests to compare non-paired non-parametric data were performed in Prism version 6 (GraphPad).Abstract P250 Figure 1Indices of multiple deprivation Non-attenders and Attenders at a Difficult Asthma Clinic between 2011–2014ResultsThe median deprivation score of postcodes of non-attenders (n = 458) was 60.69, whereas for attenders it was 51.12 (n = 505), with a p value of <0.0001.ConclusionThese results strongly suggest socioeconomic deprivation has a negative impact on attendance rates at this specific clinic. Challenging socio-economic conditions are detrimental to healthcare in multiple ways and it can be difficult for patients to access resources needed to manage their healthcare need effectively. However, we hope to assess the effect of deprivation in a control medical clinic to explore the specificity of this result to asthma clinics. It would also be valuable to investigate if these DNA rates are reflected in community clinics, as this may be an alternative way to deliver this service in order to reduce overall DNA rates in deprived areas.Reference1

AimsTo assess the use of telephone reminders in a difficult-to-treat asthma service on:1) clinic attendance rates2) the prevalence of poor concordanceBackgroundNon attendance at clinics leads to increased pressure on NHS resources and cost the NHS £3225 million in 2012–2013. Our trust has an opt-in appointment text message reminder service – despite which, the did-not-attend (DNA) rate at our tertiary asthma clinic was ≥20% in 2016. It is known that up to 30% of patients attending tertiary asthma services have poor adherence with their asthma medication.1 We were interested in establishing whether directly telephoning patients prior to review would allow us to impact DNA rate and simultaneously identify non-concordant individuals that might be redirected to specialist pharmacy input prior to clinical review.MethodsDuring a 3 month period [Feb-Apr 2017] we telephoned patients≥1 week prior to their scheduled appointment – in total 3 attempts were made to contact an individual. During successful contacts express permission was sought to access electronic prescription fulfilment data.ResultsSuccessful contact was made with 53.4% [66/126] patients – 41 did not answer, 19 had no valid contact details. The majority of those contacted [54/66] agreed to an adherence check but only n=37 had been registered on the electronic prescription fulfilment system, of these 51% [19/37] had an asthma medication pick-up rate <80%. Of those successfully contacted n=64/66 attended their appointment which compared favourably to the overall DNA rate during the same period in 2016 [3.0% vs 17.5%; p=<0.05]. Although we managed to perform a compliance check on less than a third of the total cohort [37/122], our telephone system allowed ≥1 in 6 patients [19/122]to be directed to a dedicated specialist pharmacist led clinics (focussing on optimising concordance/education) thus creating additional capacity in our difficult-to-treat asthma service.ConclusionTelephoning patients prior to clinic was associated with a substantial reduction in DNAs, and identified individuals that could benefit from a targeted intervention around concordance. The health economics of the intervention need further evaluation.Reference. Robinsonet al. Systematic assessment of difficult-to-treat asthma. ERJ2003, September;22(3):478–83.