Management of transitions to adult services for young people with eating disorders: survey of current practice in England

Aims and method The Royal College of Psychiatrists has published recommendations for managing transitions between child and adolescent mental health services (CAMHS) and adult services for eating disorders. A self-report questionnaire was designed to establish how many CAMHS teams meet these recommendations and was distributed to 70 teams providing eating disorders treatment in England. Results Of the 38 services that participated, 31 (81.6%) reported a flexible upper age limit for treatment. Only 6 services (15.8%) always transferred young people to a specialist adult eating disorders service and the majority transferred patients to either a specialist service or a community mental health team. Most services complied with recommended provision such as a written transition protocol (52.6%), individualised transition plans (78.9%), joint care with adult services (89.5%) and transition support for the family (73.7%). Clinical implications Services are largely compliant with the recommendations. It is a concern that only a small proportion of services are always able to refer to a specialist adult service and this is likely to be due to a relative lack of investment in adult services.

P-OGC63 Care Close to Home in the Era of Centralisation

Background With increasingly centralised services for people diagnosed with OG Cancer we wanted to ensure our local service was maintained to provide the appropriate care and management by collaborating with the Specialist Sites and raising the profile of local services. Most patients remain local due to their disease stage, performance status or through choice. We wanted those patients who have tests and treatment on other sites to be able to have their care managed locally as much as possible and therefore only have to travel when absolutely necessary. We aim to facilitate and deliver a streamlined service. Methods Weekly Local MDT triages patients to Specialist MDT once appropriate information is available. Established local outreach clinic for specialist service. Ensures patients are known to specialist service from diagnosis. Patients will be diagnosed and managed locally unless input required elsewhere. Local CNS attends both Local/Specialist MDT as patient advocate and provides cross site communication and care planning. Local User Involvement- contributes to service development and feedback both locally and beyond. Local HNA at point of diagnosis to establish a bench mark. Ongoing emotional support is integral to the local service and continues wherever the patient is in their care pathway. Results Streamlined care with local and specialist team contacts. Improved communication between professionals. Identifiable contact for patients Rapid referral process - timely and appropriate discussions. Improved patient satisfaction. Direct access to specialist site from point of diagnosis. Improved patient advocacy across sites Effective use of clinic time. The right patient being seen at the right time in the right hospital with the right information. Local follow up enables integration of additional local services/teams into patient care More inclusion for local teams in wider service development. Local leadership within the network has ensured investment in local services and raised the profile. Conclusions Care is more streamlined Patients are assessed by the right person at the right time enabling more open communication Avoids unnecessary referrals Less travelling between sites Reduces patient anxiety Encourages user involvement- more personalised care. Promotes continuity of patient care Allows inclusion of local teams in decision making at specialist level Promotes collaboration and team working with flexible leadership amongst team members Improved job satisfaction by establishing a shared vision Upper GI Cancer delivery will continue to go through changes but with a motivated team who work together these changes can be implemented efficiently and effectively.

The Alternative Pre-hospital Pathway team: reducing conveyances to the emergency department through patient centered Community Emergency Medicine

Background Internationally increasing demand for emergency care is driving innovation within emergency services. The Alternative Pre-Hospital Pathway (APP) Team is one such Community Emergency Medicine (CEM) initiative developed in Cork, Ireland to target low acuity emergency calls. In this paper the inception of the APP Team is described, and an observational descriptive analysis of the APP Team’s service data presented for the first 12 months of operation. The aim of this study is to describe and analyse the APP team service. Methods The APP Team, consisting of a Specialist Registrar (SpR) in Emergency Medicine (EM) and an Emergency Medical Technician (EMT) based in Cork, covers a mixed urban and rural population of approximately 300,000 people located within a 40-min drive time of Cork University Hospital. The team are dispatched to low acuity 112/999 calls, aiming to provide definitive care or referring patients to the appropriate community or specialist service. A retrospective analysis was performed of the team’s first 12 months of operation using the prospectively maintained service database. Results Two thousand and one patients were attended to with a 67.8% non-conveyance rate. The median age was 62 years, with 33.0% of patients aged over 75 years. For patients over 75 years, the non-conveyance rate was 62.0%. The average number of patients treated per shift was 7. Medical complaints (319), falls (194), drug and alcohol related presentations (193), urological (131), and respiratory complaints (119) were the most common presentations. Conclusion Increased demand for emergency care and an aging population is necessitating a re-design of traditional models of emergency care delivery. We describe the Alternative Pre-Hospital Pathway service, delivered by an EMT and an Emergency Medicine SpR responding to low acuity calls. This service achieved a 68% non-conveyance rate; our data demonstrates that a community emergency medicine outreach team in collaboration with the National Ambulance Service offering Alternative Pre-Hospital Pathways is an effective model for reducing conveyances to hospital.

Examining the relationships between social identities of British Asian transgender /gender non-conforming and well-being.

Objective: The present study aimed to explore the roles of social identity (British Asian / TGNC)against mental health problems (depression) and well-being.Methods: This study is a mixed methods pilot study. British Asian TGNC adults were our targeted subjects. An online anonymous survey was opened for four weeks and shared by some LGBTQ+ communities in the U.K. We recruited three participants, which did not meet planned sample size requirements.Results: Due to the lack of participants, we cannot reject our support any of our hypothesis. Based on the qualitative analysis, we inferred some possible findings: (1) double stigmatized individuals reported great experiences of discrimination related to their stigmatized social identity; (2) people who hold double stigmatized identity may show asymmetric identification; (3) affirmation of multiple identities could provide resilience and then foster mental health and well-beings.Conclusion: Our study demonstrated the difficulties in recruitment double minority group of people. The reasons of the failure in recruitment could be (1) double stigmatized identity may lead to concealment (2) COVID-19 causes problems in direct contact. Implications on recruitment issues within double stigmatized identities are extensively discussed, with discussions against how these areas relate to effective contact and engagement with specialist service for British Asian TGNC individuals and communities. Having a theoretical and practical understanding of these issues may address future recruitment difficulties

Type 1 diabetes management and hospitalisation in the over 25’s at an Australian outer urban diabetes clinic

AimsTo describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged >25 years attending a public outpatient diabetes service. MethodsRetrospective cohort study of people with T1D aged >25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines. ResultsAmong the 111 people with T1D (mean age 41 ± 13 years, 55% men, mean body mass index 27.1 ± 5.6 kg/m2), mean HbA1c was 8.1 ± 1.9% (66 ± 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of <53 mmol/mol (7.0%). Most people had seen a diabetes educator (80.2%) or dietitian (73.0%) and had complication screening. Complication rates were high (nephropathy 20.4%, retinopathy 27.4%, peripheral neuropathy 30.1%, ischaemic heart disease/acute infarction 10.5%). Overall, 27% of referrals occurred following an acute inpatient admission or emergency department presentation and 13% for management of diabetes in pregnancy. ConclusionsA high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a “wait for acute event” rather than “complication prevention” model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.

Police referrals for domestic abuse before and during the first COVID-19 lockdown: An analysis of routine data from one specialist service in South Wales

Background COVID-19 lockdown measures may have led to more, and increasingly severe, domestic abuse. This study examines police referrals to a specialist domestic abuse service in Wales, UK before and during the first lockdown. Methods Routine data relating to 2292 police referrals for female adult victim-survivors from December 2019 until July 2020 were analysed and presented in the form of descriptive statistics to monitor changes in referral rates and the profile of those referrals. Results There was little increase in the overall volume of police referrals during lockdown, but the proportion assessed as high risk increased, and children became the primary source of third-party referrals, with a higher proportion of reports made by other third parties as restrictions eased. Police reports for cases of Child/Adolescent to Parent Violence (C/APV) occurred almost exclusively during lockdown. Conclusions The increase in risk level despite less clear increase in volume may suggest unmet need, with victims less likely to seek help during lockdown other than for more severe instances. Increased reports by children suggest increased exposure of children to domestic abuse during school closure. Unmet need for women and children may have been made visible to services, and acquaintances, as measures began to ease.

Sexualized drug use and specialist service experience among MSM attending urban and rural sexual health clinics in England and Scotland

Background: To date, evidence on whether sexualized drug use (SDU) and chemsex occur less frequently in rural compared to urban areas in Britain has been conflicting. This study aimed to better measure and understand whether attending urban versus rural sexual health clinics in the United Kingdom was associated with a difference in men who have sex with men’s (MSM) experience of SDU or their access to SDU support. Methods: Men from 29 sexual health services across England and Scotland were recruited by self-completing a waiting room survey. Results: A total of 2655 men (864 MSM) took part. There was no statistically significant difference in recent SDU or chemsex identified in MSM attending rural compared to urban clinics. Gamma-Hydroxybutyrate/Gamma-Butyrolactone (GHB/GBL) was the most commonly reported chemsex drug used in a sexual setting, with equal prevalence of use in urban and rural MSM attendees. Distance travelled for SDU was not significantly different for rural compared to urban MSM. Rural MSM reported a higher rate of unmet need for SDU specific services, although this difference was not statistically significant. Conclusion: Within this sample of MSM, there were no significant differences in sexualized drug use behaviours between those attending rural compared to urban sexual health settings.

1076 Online Availability of Hand Splints for Patients with Common Upper Limb Nerve Entrapment Syndromes During COVID-19 Pandemic

Aim Splinting is first line treatment in mild to moderate cases of carpal and cubital tunnel syndrome. During COVID-19 lockdown, patients experience prolonged waiting time for their splints from specialist service if not requiring surgery. Many of our patients have not trialled splinting prior to their specialist appointments. We aimed to look at the quality of splints commercially available for the general public to purchase thereby starting treatment earlier. Method Hand splints for nerve entrapment are readily available through two of the biggest UK online retailers, Amazon.co.uk and eBay.co.uk. We searched the terms ‘carpal’ and ‘cubital’ tunnel splints on both sites, the top 5 results were assessed for their suitability, accessibility, and affordability. Results The average cost of splints for carpal tunnel syndrome on Amazon and eBay are £9 and £8 respectively, and £15 on Amazon and £10 on eBay for cubital tunnel syndrome. We found that all top 5 hand splints found on these websites are suitable for the conditions they advertised. The average time for free delivery of splints is 2 days for Amazon and 3 days for eBay. Splints are easily sized by using the sellers wrist/elbow circumference measurement guide. Conclusions This study has given us the confidence to encourage patients to purchase splints, at an affordable price, from online sites whilst either waiting for specialist appointments or as part of their specialist recommended treatment. With early initiation of treatment, patients may have symptomatic relief and, in some cases, avoid the need for further treatment, leading to reduced hospital footfall.

1372 Thrombocytosis and Malignancy: Management in Primary Care

Introduction The diagnosis of cancer relies within primary care to recognise this possibility in patients. Studies have shown an association of thrombocytosis with cancer, in particular lung, renal, uterine and colorectal cancer. Subsequently, suspected cancer pathways incorporate thrombocytosis in stratifying risk. This quality improvement project aimed to evaluate and improve the approach of GPs at a West London practice in managing thrombocytosis. Method A retrospective study evaluated patients with a most recent platelet count of &gt; 450x109/L. Furthermore, a survey was sent to all GPs within the practice to establish their understanding and concerns. Results were presented locally, and intervention applied following the end of the first cycle. Results The survey showed 75% (n = 9) of staff were aware of the association of thrombocytosis and malignancy. In absence of specific symptoms, 64% would consider a chest X-ray, 41% a faecal occult blood test and 16% would consider transvaginal USS in women. 28 patients were identified with thrombocytosis. Of these, 4 had underlying malignancy, 3 had an underlying haematological condition. 2 cases had a concurrent inflammatory process. Of the remaining 19 patients, 5 were referred on for specialist service. In the remaining 14, although filed as “to repeat blood test” or “speak to doctor”, 12 had yet to be actioned. Conclusions The management of thrombocytosis at a local level in primary care has room for improvement. An alert was designed and created on the online system used by the practice to safeguard missed recalls for blood tests and prompts to consider the possibility of malignancy.

What do specialist mental health professionals think of the mental health services for people with intellectual disabilities in Singapore?

Background: This research aimed to investigate the views and experiences of specialist mental health professionals working with adults with intellectual disabilities and mental health problems in Singapore in order to gain insight into the functioning of the local specialist intellectual disability mental health service and how it may be improved. Methods: Eight staff members from specialist service were interviewed. The transcriptions of the interviews were analysed using thematic analysis. Results: Analysis revealed four themes (1) Identifying their roles; (2) Ensuring continuity of care; (3) Disempowerment of service users and (4) Improving clinical practice. Conclusions: Participants identified the challenges they faced working with this population. They highlighted the importance of building therapeutic relationships during the treatment process and discussed the stigma that people with intellectual disabilities face in the community. Recommendations and implications are discussed in relation to service provision, improving staff knowledge and recruiting more staff to work in this field.