Better prescribing, improved safety, less visits and reduced risk of complications for incompliant patients in General Practice
Figures have suggested that more than twelve million GP appointments are missed each year in the UK, costing in excess of £162 million per year. Ultimately it is not about the financial cost, but the opportunity cost to the NHS – GPs are not able to offer these appointments to others and as a result patients were waiting longer because appointments were being wasted.
Castle Street Medical Centre have embraced the essence of what is possible with the simplest of support for patients struggling to engage with, adhere to, or comply with their shared healthcare management plan under normal care. Using a range of deceptively simple methods, techniques and psychology unique to Simple Telehealth & Florence, this team have enabled the most incompliant patients to transform their own care.
Castle Street Medical Centre demonstrated a high DNA rate and in an attempt to improve patient attendance at scheduled appointments, Flo was introduced in June 2014.
- Purpose of Use for Improving Attendance at Castle Street Medical Centre:
- To support the shared management plan agreed with the health care team, increasing the patient’s awareness of their condition and empowering the patient to take responsibility for their adherence to their agreed treatment plan and associated requirements
- To support appropriateness of treatment (and/or prescribing) due to improved interaction with and ability to review patients
- To actively promote and encourage sustained behaviour change and engagement with condition.
- Reduce avoidable healthcare usage and crisis episodes, (e.g. attendance at GP surgery, Out of Hours, Walk-in Centres or A&E) resulting from a poorly controlled condition due to non-attendance and subsequent management.
From the patients who have accessed Flo’s support, 3 cases have been randomly selected to understand the transformation that Flo has brought to the practice:
Case 1 (PB) (E023)
This gentleman is on Warfarin and as such has monthly clinic appointments to check his INR level to ensure the correct dosage of warfarin was prescribed. However this patient regularly used to forget his appointment and did not attend the clinic. Indeed from March 2014 to March 2015 the patient missed 6 / 12 (50%) of appointments resulting in an extra 6 appointments needing to be rescheduled. Demonstrating that the patient was not engaged in the management of his warfarin, this 50% DNA rate not only increased costs associated with administrative time and resources required to reschedule appointments but also wasted capacity and clinical time for each appointment the patient did not attend. The patient was introduced to Flo in March 2015 and has subsequently had 100% attendance for his clinic appointments. According to the patient. Flo has transformed his life, the patient’s INR is monitored more effectively leading to more appropriate prescribing and improved patient safety with less visits reducing the patient’s risk of complications associated with INR levels.
Case 2 (AJ) (E025)
AJ needs Vitamin B12 injections every 12 weeks. However, in 2014 AJ only managed to have 2 injections because she kept forgetting to make appointments. Consequently this increased the risk of illness because of lack of Vitamin B12. AJ was introduced to Flo on 28th January 2015 and since then AJ have 100% of attendance and no longer miss her appointments.
Case 3 (SW) (E024)
SW has learning disabilities and uses Depo Provera as injections a contraceptive method. Unfortunately she used to miss her appointments regularly increasing the risk of pregnancy. This non-attendance incurred added cost for administrative procedures, extra pregnancy test due to the requirement for the patient to start the protocol again as the window for the injection had been missed, and not to forget staff cost for missed and added appointments. In 2014 she missed 2 out of her 5 appointments resulting in 2 extra appointments being generated as result. SW was introduced to Flo on the 19th January 2015 and since then she has not missed an appointment once demonstrating 100% attendance. Since commencing with Flo, SW reports feeling a lot less stressed due to having peace of mind that Flo will remind her when the next appointment is due.
Judy Deenham is a Practice Nurse using Flo and describes Flo as a saviour because now the most incompliant patients no longer miss their appointments.
In addition to the healthcare costs avoided due to better prescribing, improved safety and reduced risk of complications for incompliant patients, the direct cost savings are illustrated below.
Associated direct savings realised as a by-product of care transformation for 3 patients.CATEGORIES: medical reminders