M22 Does telephoning patients before the difficult-to-treat asthma clinic improve attendance?

Abstract

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.