By Elliott Engers, CEO, Infinity Health

This article was first published in Health Tech World.

Under national targets for 2022/23, NHS trusts have been asked to reduce outpatient follow-ups and expand the uptake of patient initiated follow-up (PIFU) in all major outpatient specialties.

PIFU means that patients or their carers request care as and when they need it, rather than being automatically called back for an appointment.

This empowers patients to take control of their own health, while freeing up appointments for those who need them the most.

Traditionally, patients with chronic conditions or who have had surgery, are offered hospital follow-up appointments following a routine or fixed schedule (such as every three months).

Often these can be unnecessary by the time of the appointment, and they can also be inconvenient for the patient due to travel, financial cost, or time off work.

On a PIFU pathway, patients can initiate a follow-up consultation at any time, usually when they experience a flare up or change in their condition, and they are able to access care quicker than through traditional methods.

This allows hospitals to remove unnecessary follow-up appointments and make space for new patients, whilst improving the patient experience, and minimising ‘Did Not Attends’ (DNAs).

For people living with long term health conditions, an appointment may not be needed at all and could be replaced with blood tests at intervals or a digital follow-up assessment form that the clinician can review before deciding on next steps.

Increasing health inequalities

One major gap in the research and development of PIFU is whether and how PIFU might affect health inequalities.

Before PIFU is scaled up in the NHS, it is important to understand which patients are being selected for PIFU and how their needs are being responded to or escalated.

Patients may be unable to engage digitally or initiate follow-up, for example, because of a lack of knowledge or judgement of when to call their clinical team, not feeling confident to reach out, language barrier or other incapability.

Six per cent of all homes in the UK do not have access to the internet, meaning 1.5 million people are offline, according to data from Ofcom.

Many of these include disabled people, older people, and households with low incomes.

We must ensure that a PIFU pathway is suitable for every patient placed on it and that there are measures in place to monitor engagement. New pathways call for new solutions to ensure that we don’t leave the most vulnerable people in society behind.

Technology can play a key role

It is crucial that PIFU is implemented in a way that bolsters trust between clinicians and their patients, while supporting people to notice and act on changes in their symptoms.

Currently, many trusts that have PIFU are using spreadsheets or lists which are not integrated to manage PIFU patients.

To feel the full benefits of PIFU, we must transform this pathway using digital tools, making outpatients management more efficient, more automated, and safer.

Digital platforms can be used to coordinate and manage PIFU associated activities, such as digital assessments, appointment booking, patient messaging, and more.

For example, a patient on a long term pain management PIFU pathway could be sent specific questionnaires or PROMs at six monthly intervals to assess their symptoms and overall clinical condition.

Relevant clinicians would be notified of completed questionnaires and be able to view the information detailing the patient’s experience of their condition.

Subsequent actions could then be taken, for example to review medication or order blood tests or other investigations, to make an appointment, or refer to colleagues.

The patient can be informed of the decision and how to take this action and book the appropriate follow up at a convenient time for them.

Setting up automated messages at key milestones ensures patients not seen within a certain window aren’t forgotten, and vulnerable groups won’t be disadvantaged with critical issues going unnoticed.

If a patient on a PIFU pathway hasn’t activated it themselves, the consultant can also then choose to contact the patient and check in on them, which is referred to as a CIFU (Clinician Initiated Follow Up).

PIFU isn’t going to solve digital exclusion; it remains an ongoing problem which must be tightly managed.

For example, patients who do not digitally engage whilst on PIFU must be identified and selected for a ‘check-in’ with an SMS or phone call.

Similarly, provisions must be made for those who lack the capacity to access digital healthcare as a matter of routine for any new digital solution.

Using digital tools can make PIFU much more efficient, giving patients more control over their care and providing a personalised way to communicate with and feel supported by, clinicians if needed.

Clinical staff can quickly identify issues, prioritise vulnerable patients, take action when needed, and ensure that patients are not lost to follow-up.

Now is the time for trusts to invest in digital solutions to support PIFU in a safe and efficient way and prevent the acceleration of health inequalities.