Abstract Background/Aims Patients with axial spondyloarthritis (axSpA) often experience long waits for referral and follow-up appointments in NHS rheumatology services, resulting in an average diagnostic delay of ∼8 years and poorer outcomes. Patient-initiated follow-up (PIFU) allows patients to schedule follow-ups according to need, while enhancing clinical capacity and service efficiency. Here we report a computer modelling study estimating the potential impact of PIFU, with varying intervals for routine follow-up appointments, on patients with axSpA and their NHS service’s performance. This modelling complements the real-world evaluation of PIFU in an NHS hospital - part of the FASTRAX initiative deploying a digitally supported PIFU pathway that aims to improve outcomes for patients with axSpA. Methods Discrete-event simulation was used to model patient flow through an NHS rheumatology service over 5 years, capturing random variation, patient attributes and limited clinic capacity for new-referral and follow-up appointments. Input parameter estimates were sourced using electronic hospital records, scientific literature and clinician advice and could be modified for different modelling requirements. Using these parameters, we simulated a baseline scenario (“usual care” without PIFU) and three PIFU scenarios with 18/24/30-month follow-up intervals. Key performance indicators, such as appointment waiting times, were averaged from 100 five-year simulation runs per scenario. Results All scenarios assumed an average new referral rate of 8 patients per week and non-PIFU follow-up intervals of 3 months or 12 months for patients undergoing treatment with unstable or stable disease, respectively. PIFU scenarios assumed a 50% chance that a stable patient would move onto the PIFU pathway. Compared to the baseline scenario in simulations, PIFU substantially reduced the number of patients waiting for appointments and appointment waiting times for both new and registered patients, with longer follow-up intervals further improving access to appointments (Table). Conclusion Computer modelling results indicated the potential benefits of PIFU for freeing up clinic capacity and improving patient access to appointments. Additional simulation experiments and empirical evaluation of PIFU in a real-world NHS setting are planned as part of the second phase of the FASTRAX initiative, which aim to evaluate the feasibility of its implementation in practice, including the preferred monitoring interval. Disclosure C. Vasilakis: Grants/research support; C.V. received funding from UCB to carry out this study. S. Khodaee: None. E. Fichera: Grants/research support; E.F. received funding from UCB to carry out this study. C. Cavill: Grants/research support; C.C. received grants from Abbvie, Eli Lilly, Novartis, and Pfizer. J. Benawra: Other; Employee of UCB. J. Gandrup Horan: Shareholder/stock ownership; UCB. Other; Employee of UCB. S. Tuytschaever: Other; Employee of UCB. A. Bessa: Other; Employee of UCB. R. Sengupta: Honoraria; R.S. received honoraria for giving talks from Abbvie, Biogen, BMS, Lilly, MSD, Pfizer, Novartis, Roche, and UCB. Grants/research support; R.S. previously held unrelated grants from Abbvie, Novartis, Pfizer and UCB. Other; R.S. has represented Abbvie and Novartis at NICE technology appraisals.
Vasilakis et al. (Wed,) studied this question.
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