P010 Patient-initiated follow-up: optimizing dermatology resources

Abstract Outpatient referrals to dermatology have increased significantly in the last 10 years and are expected to continue to grow, widening the demand–capacity gap and increasing pressure on an already strained service. The British Association of Dermatologists (BAD) lists patient-initiated follow-up (PIFU) as a waiting-list management tool. In March 2024 the Health Service Executive (HSE) in Ireland also released a national guidance document on the implementation of a PIFU pathway with anticipated benefits including reduced unwarranted review appointments and ‘did not attend’ (DNA) rates. Patients attending our centre are offered PIFU when their condition is well controlled but may warrant further dermatology input if it flares. A written information leaflet on PIFU is provided. This is valid for 1 year and pertains to the same clinical condition only. We performed a single-centre retrospective review of patients offered a PIFU between July and October 2023 to assess its impact on our service. Patients were identified through electronic reports for adult and paediatric dermatology clinics, and additional data were collected from clinical charts including patient demographics, diagnosis and whether the activation was appropriate. An activation of PIFU was labelled inappropriate if the complaint did not pertain to the original condition or if the patient subsequently did not attend. In total, 108 patients were offered a PIFU, 65 female (60%) and 43 male (40%), with a median age of 25 years (range 1–85). This represents approximately 7.5% of patients reviewed during that timeframe. Clinical diagnosis included atopic dermatitis (23.1%), acne (15.7%), psoriasis (13.8%), nonspecific rash (12%), infantile haemangioma (5.5%), folliculitis (4.6%), urticaria (3.7%), infection (3.7%), lesions (3.7%) and other (13.8%). Within the 12-month period, 24 patients (22.2%) activated their PIFU, and the median time until PIFU was 305 days (range 14–462). Of these 24 patients, three reactivations were identified as inappropriate. Two patients did not attend their appointment and one patient’s reason for activation did not align with the rationale for offering a PIFU. The remaining 84 people had no further episodes of care during the study interval and were discharged. The background rate of patients who DNA in our department in 2023 was 9.2% (1167 of 12 656), which is significantly lower than the estimated national DNA rate, which was approximately 14%. These findings align with national guidance, supporting the broader implementation of PIFU as a practical strategy to address capacity challenges in dermatology services.