Patient initiated follow up in Obstetrics and Gynaecology: A systematic review

The demand for outpatient hospital appointments has risen steadily over recent years, almost doubling since 2008; now standing at 120 million appointments per year. Initiatives to reduce unnecessary appointments are a key area of interest, as they can be an effective way of both improving patient care and satisfaction, as well as reducing NHS costs. Patient Initiated Follow-Up (PIFU) provides an alternative to traditional hospital instigated follow-up, by which patients have autonomy in their future care, allowing them to make appointments based on their own perception of need. PIFU has proved successful when implemented in Rheumatology, Inflammatory Bowel Disease and Oncology, with trends towards reduced burden on outpatient appointments, improved patient satisfaction and lower costs. To-date, the use of PIFU in women's health has been limited to gynaecological oncology, where observations include high patient satisfaction and fewer appointments than traditional follow-up. This study aims to undertake a systematic review of the literature relating to PIFU in Obstetrics and Gynaecology in order to identify evidence-based indications for PIFU in the specialty, as well as form a foundation for a subsequent service evaluation.

The project was registered with Prospero, University of York. Using the OVID platform, a literature search was conducted using the terms "patient initiated follow up", "gynaecology", "women's health", and "follow up care". Papers were then screened in accordance with the PRISMA protocol, and relevant articles identified based on our inclusion criteria. The quality of the studies was assessed using the Newcastle-Ottawa Scale, and data from the studies were extracted and compared.

Eight papers were identified as relevant, two were randomised controlled trials, three were retrospective cohort studies, and the remaining three were prospective cohort studies. The majority of these studies (5/8) were of good quality, scoring 6 or more points on the Newcastle-Ottawa Scale. Four of the eight studies examined cost-effectives; all reported cost-savings relating to PIFU. Seven of the eight studies also reported an association between PIFU and greater patient satisfaction, fewer overall appointments and reduced non-attendance. One study reported no effect on patient satisfaction. Five studies related to gynaecological oncology, two were obstetric and one urogynaecology. The studies which investigated PIFU use in selected gynaecological oncology patients reported that PIFU did not have a negative impact on detection of cancer recurrence, but evidence regarding the psychological impact of PIFU on cancer survivors was conflicting.

PIFU was received largely positively and was well accepted by women across these studies. It was also shown to be cost-effective, without a negative impact on health outcomes. PIFU also has the potential to offer additional benefits including reducing diagnostic delay and increasing patient engagement with their own health status. This review found a paucity of data for PIFU in Obstetrics and Gynaecology, with the exception of gynaecological oncology, and further evaluation is required before more widespread implementation.