Patient-related outcomes in patients referred to a respiratory clinic with persisting symptoms following non-hospitalised COVID-19

Survivors of COVID-19 can present with varied and persisting symptoms, regardless of hospitalisation. We describe the ongoing symptoms, quality of life and return to work status in a cohort of non-hospitalised COVID-19 survivors with persisting respiratory symptoms presenting to clinic, who consented and completed patient-reported outcome measures. We identified fatigue, reduced quality of life and dysregulated breathing alongside the breathlessness. Those with co-existent fatigue had worse mood and quality of life and were less likely to have returned to normal working arrangements compared to those without fatigue. For non-hospitalised people with persisting symptoms following COVID-19 referred to a respiratory assessment clinic, there was a need for a wider holistic assessment, including return to work strategies.

Drug Use Evaluation Among Elderly Patients With History of Falling in Geriatric Assessment Clinic, Ramathibodi Hospital

Background: Drug use evaluation as an intervention approach for fall prevention has an effect on most drug-related outcomes. Geriatric assessment clinic provides comprehensive care in elderly patients. All prescribed or non-prescribed medications were evaluated by pharmacists. Objective: To study the drug and drug-related problem among elderly patients with history of falling. Methods: This is a cross-sectional study of elderly patients with history of fallings. Demographic data, health information, history of falls, and drugs use evaluation were obtained from their medical records in year 2010 to 2020. Linear regression model was used to examine the multivariate correlates to number of fallings. Results: A total of 183 patients with history of falling were studied. Of this, 97 had recurrent falls. Most patients (77%) had more than 5 underlying diseases and over half (55%) had dementia. Drug-related problem were found 69.4%, 4 in 5 of patients used 5 types of the medications or more. The diabetes drugs were found to increase risk of recurrent falls significantly (OR [95% CI], 2.11 [1.03 - 4.33]; P < .05). Conclusions: Most elderly patient with history of falling have drug-related problem (69.4%) and multiple morbidities including dementia. The diabetes drugs were 2 times significantly increased risk of recurrent falls. This study highlights the important of drugs management in this vulnerable group of elderly patients.

TP7.2.17 Are there any predictable trends in the pattern of two week referrals for suspected gastrointestinal cancers?

Aims Patients with suspected cancer are referred to secondary care on the “two week wait” pathway. Investigation and management of these patients is resource intensive and puts a significant strain on services. We aim to determine if there are predictable trends in quantity of referrals or cancer detection rates (conversion rates) for suspected upper and lower gastrointestinal cancers. Identifying such trends could guide future resource allocation and provision of services. Methods Two week wait referrals to upper and lower gastrointestinal clinics between 2015 and 2019 were included. The number of referrals and conversion rates were analysed on monthly, quarterly and annual basis. Results Upper GI total referrals: 1094 in 2015 vs 1357 in 2019. Lower GI total referrals: 1827 in 2015 vs. 3278 in 2019. Upper GI conversion rates: 8.8% in 2015 vs. 8.36% in 2019. Lower GI conversion rates: 6.47% in 2015 vs. 4.07% in 2019. There were no identifiable significant trends in referral numbers or conversion rates when analysed on a monthly and quarterly basis. Conclusions The number of two week wait referrals for suspected cancers has shown a sustained year on year increase. Conversion rates for the time period have remained somewhat static and in some cases decreased. Our data shows no evidence of any spikes or troughs in demand related to the time of year. Should demand continue to rise at the current rate then alternate modes of assessment such as telephone assessment clinic or a straight to test approach may become more widespread.

The diagnostic trajectory in autism and intellectual disability in Quebec: pathways and parents’ perspective

Background This paper aimed to describe the diagnostic service trajectory of families of children with autism or intellectual disability in the province of Québec and identify predictors of parents’ perceptions of its quality. Methods The Evaluation of the services Trajectory in Autism by Parents instrument was completed by 259 parents at an assessment clinic. Children’s clinical records were also examined. Results On average 26 months elapsed between their first concerns and their child’s diagnosis, a period during which few (25%) received support. Parents’ evaluations were generally positive but were lower for the accessibility of the pre-assessment phase and the flexibility of the assessment process. Longer delays and a greater number of professionals consulted were associated with lower quality ratings. Some language-, immigration status-, and income-related differences in families’ appraisals were noted. Conclusion The diagnostic trajectory for neurodevelopmental disorders within public services in Québec presents some efficiency and accessibility challenges. Possible improvements are proposed to facilitate screening and to support families throughout this phase of their trajectory.

An evaluation of the Stratford multiagency, multidisciplinary, assessment clinic

Purpose This study aims to assess a novel clinic whereby new patients were discussed in a multi-agency, multi-disciplinary panel and given feedback on the same day. The objectives were to determine the impacts on time to commencing treatment, need for further assessment, discharges and staff and patient experiences. Design/methodology/approach Outcomes from the new assessment clinic were compared to previous individual assessments. Feedback questionnaires were given to patients, while a focus group was conducted with staff. Findings There was a significant reduction in the time to agreeing a treatment plan (34 days to <1 day), the need for further assessment (61%–23.2%) and a significant increase in the proportion discharged from secondary care (26.9%–49.8%). Clinician and patient feedback on the clinic was positive. Practical implications The model of a multi-agency, multi-disciplinary clinic could be used for assessing new referrals to community mental health teams. Originality/value The use of a multi-agency, multi-disciplinary clinic is a novel approach within community mental health teams which led to improvements in efficiency, while demonstrating positive patient and clinician feedback.

Telehealth outpatient coronavirus disease 2019 case management at a tertiary hospital in Sydney

Introduction Coronavirus disease 2019 is an acute respiratory illness caused by severe acute respiratory syndrome coronavirus 2. The coronavirus disease 2019 pandemic upended the traditional paradigm of face-to-face provision of healthcare in the Australian context; as such, a telehealth model of active case management was implemented in our public health system, even though there was little supporting data for the safety of delivering patient care remotely to home-isolation patients in the setting of a highly infectious and potentially fatal illness. Methods A retrospective, single-centre, observational cohort study was performed over 6 weeks commencing 12 March 2020, including patients with coronavirus disease 2019 undergoing home isolation and being actively monitored by a coronavirus disease 2019 telephone assessment clinic. Outcomes assessed comprised: duration of active case follow-up, average number of telephone calls per patient, average number of hours managing each patient, treatment required including presentation to the emergency department or admission to hospital, patient characteristics and utilisation of other health services. Results Of 5223 severe acute respiratory syndrome coronavirus 2 tests performed, 170 individuals (3.25%) tested positive. A total of 158 were included: 76 (47.5%) male and median age 31 years (range 18–94). Median symptom duration was 13 days (interquartile range 6, range 2–34). Median length of coronavirus disease 2019 telephone assessment clinic admission was 10 days (interquartile range 7, range 3–32). A total of 1151 telephone patient encounters were undertaken, with a median of six phone calls made to each patient (interquartile range 5, range 1–20). Ten patients required repeat clinic review; all but one returned home. Six presented to emergency department, with three of these being admitted. In total, there were six admissions: one from the clinic, three from the emergency department and two direct from home (bypassing emergency department). Only four of the six admissions (or 2.5% of all patients) required low-flow oxygen therapy; none required high-flow oxygen or assisted ventilation. The remaining 140 patients (88.6%) were safely managed at home without complications. Discussion A telehealth model of care is safe, efficient and cost-effective for the management of mild-to-moderate coronavirus disease-19 and facilitates home isolation, especially of a low-risk population, thus providing reassurance that this model is sound and suitable for ongoing use.

772 Quality Improvement Project – Establishment of The Breast Pain Clinic at Torbay Hospital

Introduction Breast pain alone should not be imaged. The common misconception that breast pain alone is a symptom of malignancy and the subsequent impact on the Triple Assessment Clinic (TAC), lead to the development of the Breast Pain Clinic (BPC), a holistic service to educate patients and reduce unnecessary imaging. Method Retrospective data was collected of TAC attendees between September-December 2018, noting patients presenting solely with breast pain (BPP); number of BPP imaged; and those with positive results. Prospective data collection of those attending the TAC and BPC were collected between September-December 2019. Results Retrospectively 17% (151/888) of TAC attendees were BPP, 23.8% (36/151) were imaged and 97.2% (35/36) had normal/benign changes. Following BPC creation 7% (67/940) of TAC attendees were BPP, 31.3% (21/67) were imaged all with no positive results. 1% (3/94) of BPC attendees were BPP, all with normal/benign imaging. 96% of questionnaire respondents felt more confident managing breast pain. Conclusions The development of a BPC was successful in educating patients and reducing anxiety. It also reduced the proportion of patients presenting to the TAC with pain and the proportion of patients imaged. With further education of community practitioners on referral adherence, this service could benefit breast services nationwide.