Ensure support for digital based patient-initiated follow ups, experts say

Adopting digital based patient-initiated follow up models offers patients more control over their care, but support is needed to insure it works for individuals, experts have said.

It comes as new guidance issued by NHS England on phase three of the health service’s response to Covid-19 recommended the use of patient-initiated follow-up (PIFU) processes in secondary care.

PIFU, alongside digital-first approaches, can play a “key role” in enabling shared-decision making and supporting patients, the guidance states.

Responding to the focus on patient-initiated solutions Graham Kendall, director of the Digital Healthcare Council, said evidence “overwhelmingly” suggests patients who are actively involved in managing their care do much better.

“Given there is no ideal one size fits all for follow-up interventions, patient initiated follow-up is potentially a great opportunity to shape care around individual needs. In turn, we can offer more efficient provision while crucially improving outcomes and achieving a better experience,” he told Digital Health.

“However, we need to manage the risks carefully. Clinical need, levels of understanding that patients have about their conditions, anxiety, access to services and concerns about stressing an over-burdened system will all influence patients’ decisions to initiate follow-up.”

Kendall adds it’s “essential” to give patients the support they need in order to use PIFU services.

“Just as digital triaging can help channel patients to the right place at the beginning of their care, we can build similar approaches to support patients through their follow-up journey,” he said.

“This support must be individualised, responsive and available to all. We already have many of these elements in place, but the PIFU policy brings new urgency to integrate these solutions and adopt them more widely.”

The new guidance provides advice on implementing PIFU services which “can be used for patients of any age, provided the patient and their clinician agree that it is right for them”.

Such services encourage patients to “engage” with their health; helps clinicians manage their caseloads; provides confidence that patients know how to contact service; and can reduce waiting times and ‘did not attend rates’.

This will become especially necessary as the health service works through a backlog of appointments postponed or unattended during the pandemic.

Tom Whicher, founder of digital healthcare company DrDoctor, said PIFU models will be key to “restarting and resetting services” in the NHS.

“If implemented successfully, it can achieve the following three things: patient agency and empowerment, a reduction of the administrative burden on hospitals and ensuring patients come to hospital when they need to be seen rather than when they are told to,” he told Digital Health.

“At DrDoctor’s core is the idea of patient engagement. This means offering people control of their own healthcare and what better way of giving people control than enabling them to book a follow-up appointment when they feel they need it.

“It is the beginning of the end of the traditional, paternalistic ‘I’m going to tell you when to come in’ type of a model. From now, people will feel like responsible partners in their own care, not just passengers on a journey.”

Kendall and Whicher both took part in a recent episode of Digital Health Unplugged looking at how digital tools could be used to ease the backlog of NHS appointments caused by the Covid-19 pandemic.

You can listen to the podcast here, or on our Spotify and Apple Podcasts channels.