In our previous intro blog we talked about a recent Cochrane systematic review on the use of patient-initiated appointment systems for managing the care of people with chronic or recurring conditions in secondary care.

This is the second of a series of blogs looking at PIAS from different perspectives. Each blog will provide a different perspective from that of a service user (patient), a clinical nurse specialist, a consultant, a service manager to that of a health service commissioner. These blogs aim to stimulate the conversation around the future of high quality and sustainable care management for those with long term, recurrent or chronic (and perhaps multiple) conditions.

The clinical nurse specialist perspective


So who are you and what do you do?

Our names are Nikki Day and Sarah Harvey and we are part of the Specialist Nurse team in Rheumatology at Derriford Hospital in Plymouth. Nikki enjoys gardening whilst Sarah enjoys trips with her dog.

What is your involvement with Patient-initiated appointment systems (PIAS)?

Our involvement with PIAS was initially as a research project. Nikki took the lead as Specialist Nurse with Dr Perry, Consultant Rheumatologist taking overall responsibility for research. The research was to evaluate patients having standard, regular follow- up versus those making their own appointments when required. The end results identified that as long as patients were assessed as being able to decide when medical help/intervention was required that the PIAS process was both beneficial to medical staff and patients.  Patients, who were assessed as appropriate for this approach, were patients whom were able to confidently and competently contact the service appropriately.

Sarah now has a great knowledge of delivering this service and regularly educates patients of how this process works, either face to face or via a telephone clinic. Both Sarah and Nikki have found this service to be a positive change for both patients and clinicians, to be able to access quicker appointments when needed to assess disease activity.

What do you see as the main advantages of the PIAS approach?

It has been a very advantageous change in allowing patients to be reviewed quickly and as clinicians to be able to monitor and assess active disease. We both feel it has prevented reviewing patients where there is no clinical reason and patients report this system of accessing appointments to be very beneficial due to the fact their medical issues are addressed promptly.

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Photo by Drahomír Posteby-Mach on Unsplash

What do you feel needs further development or consideration?

Further development around the PIAS system, could be considered for other long term condition services adopting this system. However, we both feel that more education early on in the diagnosis and management of rheumatological conditions would better support patients to recognise when to initiate an appointment (and this could also be applicable to other conditions).

What would be your top tips for those considering using a PIAS approach?

Our top tip, reflecting on the early research undertaken from this system, patient education was identified as paramount. A full understanding of how the system works was identified as leading to an improved outcome for clinicians and patients and appears to have reduced routine follow- ups. It would be beneficial for the whole multi-disciplinary team to be involved and engaged in this system to allow patients quicker and appropriate access to the relevant clinician (e.g. Physiotherapy and Occupational Therapy).

What have you learned from your experience of PIAS and what advice would you give to someone considering starting one?

It could be suggested that the delivery of PIAS to patients does not always need the knowledge of a Consultant Rheumatologist or a Specialist Nurse, as this could include other members of the multi-disciplinary team, i.e Occupational Therapist and Physiotherapists who are also on board with this approach. However, this is just a snap-shot of the PIAS system which could be discussed in much deeper detail.

With many thanks to Nikki and Sarah for agreeing to share their experience (and photos!).

The next blog in the ‘Perspectives on patient-initiated appointment systems’ is ‘The Consultant‘.

Previous blogs in this series: Introduction, The Service User.

You can also listen to two of the authors discuss the Cochrane systematic review that underpins this work on this podcast.