Patient-initiated follow-up in gynaecology: Patient and clinician views

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 298; pp. 18 - 22
• Main Authors: Chainrai, Mira, Kershaw, Victoria F., Gray, Thomas G., Radley, Stephen C.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-07-2024
• Subjects: Adolescent; Adult; Aged; Attitude of Health Personnel; Female; Gynaecology; Gynecology; Humans; Male; Middle Aged; Patient Satisfaction - statistics & numerical data; Patient-Initiated Follow-Up; Self-Monitoring; Survey; Surveys and Questionnaires; United Kingdom; Women’s Health; Young Adult; United Kingdom; Gynaecology; Survey; Patient-Initiated Follow-Up; Self-Monitoring; Women’s Health
• ISSN: 0301-2115; 1872-7654; 1872-7654
• DOI: 10.1016/j.ejogrb.2024.04.032

•Time fixed follow-up appointments can lead to reduced flexibility and reflexivity for patients with deteriorating/improving symptoms and conditions.•Patient initiated follow-up in gynaecology can create a follow-up process which could better suit patients needs and make outpatient departments more efficient.•This study shows that patients and clinicians are overwhelmingly positive about the benefits of patient initiated follow-up.•Patient initiated follow-up requires robust symptoms to ensure safety and high-quality information for patients put on such pathways, which should also ensure equity of access for those with additional needs.
Follow-up appointments in the UK National Health Service account for up to two thirds of outpatient activity, but there is a significant resource impact in providing time fixed follow-up appointments. Increasingly patient initiated follow-up is being used, to make follow-up appointments work better for patients both in terms of timing and necessity, and to reduce unnecessary outpatient activity. The objective of this study was to use a modified questionnaire to evaluate patient and clinician views regarding Patient-Initiated Follow-Up (PIFU) in gynaecology services and identify subgroups suited to this pathway of care.
Participants including both patients and clinicians were recruited from a gynaecology outpatient department. Patients who have poorer access healthcare (with disabilities and black and ethnic minority background) were purposively targeted so their experiences could be included. Value and burden scores were evaluated using patient and clinician surveys based on a modified QQ-10 questionnaire which assessed perceived value and burden of patient initiated follow-up in gynaecology. Free text comments regarding PIFU were also collected.
305 patients and 30 clinicians were surveyed. Overall response to patient initiated follow-up was positive. Patients and clinicians attributed high value (77.4 % and 81.4 %) and low burden scores (37.5 % and 44.7 %) to PIFU. Patient autonomy was cited as a reason for this by 84.6 % of patients and 93.3 % of clinicians. Patients attending benign gynaecological sub-specialties including endometriosis (84.2), general gynaecology (82.5) and vulval clinics (81.4) attributed the highest value scores. Gynaecology oncology patients attributed the lowest value (64.0) and highest burden score (51.3) of all subgroups. Younger adults (<60) were more likely to express a preference for PIFU (52.9 %) than older adults (≥60) (28.6 %).
In this study, both patients and clinicians are in favour of selected use of PIFU in gynaecology services. Both questionnaires found younger patients with benign gynaecological conditions were perceived as best suited PIFU. We recommend offering PIFU to select patients who are confident in self-monitoring, factoring patient choice so patients are not disadvantaged by this system. Further evaluation of PIFU in practice is needed before widespread implementation.