P079 Treatment and referral pathways for hair loss in the National Health Service: a patient survey

Abstract Alopecia areata (AA), female pattern hair loss (FPHL) and frontal fibrosing alopecia (FFA) are three types of hair loss in which patients may benefit from comprehensive and complex treatment decisions in secondary and tertiary dermatology centres to prevent progression of hair loss, promote regrowth and access specialist therapies. Patients face various barriers that delay access to National Health Service dermatology assessment and personalized therapies. In this study we surveyed 85 patients with AA, FPHL and FFA attending a specialist hair clinic regarding their treatment and referral pathway from general practitioner (GP) assessment into hospital care. Patients were offered the option to complete a paper copy or fill in the survey online (via SurveyMonkey). Ethical approval was obtained from the London-Surrey Research Ethics Committee. Full responses were received from 82 patients, 76 (93%) of whom were female. In terms of ethnicity, 89% reported as White, 7% Asian and 4% Black or mixed. The majority of respondents were diagnosed with AA (59%). Patients reported various barriers to early treatment of alopecia, including delay in access to specialist dermatology care. In the sample surveyed, 88% stated that the first healthcare professional seen was their GP, with median waiting time of 2 months [interquartile range (IQR) 2–6] before their first medical visit. About 61% tried over-the-counter or home remedies before seeing their healthcare professional. Unfortunately, only 30% felt they were given the correct diagnosis by their GP, with just 26% happy with the explanation given on their first encounter. Only 35% reported receiving alopecia treatment by their GP, and 95% of patients felt they were not offered any psychological support. Furthermore, 41% experienced difficulty in getting a referral from their GP to see a dermatologist, with a median waiting time of 12 months (IQR 12–24) before seeing a dermatologist. In comparison, on their first dermatologist visit, 78% felt they were given the correct diagnosis, 82% received treatment for their alopecia, 66% were happy with the care and explanation given and 61% reported no difficulty getting referral from their first dermatologist to a specialist hair clinic. The median waiting time before first being seen in the specialist hair clinic since hair loss was 3 years (IQR 3–5). Overall, this study showed that patients faced various challenges including accurate initial diagnosis, limited treatment options and delays accessing appropriate dermatology care. Patients would benefit from solutions to mitigate delay around their early alopecia treatment that provide accessible and appropriate (secondary or specialist) dermatology care while taking into consideration their preferences and values.