There is an increasing drive across outpatient services to move away from routine follow-up appointments at regular intervals. Increasingly, services are being encouraged to enable patient-initiated review or follow-up. Policy makers see this as an enabler in elective recovery as it has been shown to reduce appointments (patients appear to come back less when in control of their review). A number of elements need to be in place to ensure patient-initiated review is safe, effective and satisfactory to the patient, including remote monitoring, advice lines, and support for self-management.

BSR and its members have been at the forefront of developing practice and policy in patient-initiated review/follow-up and national guidance can be found across England, Scotland and Wales.

Remote monitoring is the process of using technology to monitor patients outside a traditional care setting, such as in their own home, and is gaining in prominence as routine follow-up is reduced. Remote monitoring principally relies on technology but can take many different forms: monitoring devices, online completion of Patient Reported Outcome Measure questionnaires, app-based symptom trackers, and more. Developing technology is time and cost intensive but BSR members across the UK are pioneering approaches, which we showcase here.

Best practice case study: Oxford University Hospitals NHS Foundation Trust (a digital solution for monitoring patients)

Best practice case study: Oxford University Hospitals NHS Foundation Trust
In response to the COVID-19 pandemic, the rheumatology team at Oxford University Hospital NHS Foundation built a digital way of working to remotely monitor the health and wellbeing of patients with rheumatological conditions. It involved patients being sent links to a set of online questionnaires via text or email. The answers are sent securely to the hospital where the medical team can view the summarised data together with the patient’s record.

Pre-pandemic, the team assessed 10-12 patients in-person an afternoon. With the digital system in place the team can review 6-8 patients in an hour, and the patient does not have to travel to the hospital. These efficiencies and the potential for this work to spread quickly to other specialities led to the team being awarded a BSR Best Practice Award in 2022.

    Best practice case study: Guy’s Hospital (using technology to solve unmet need)

    The rheumatology team at Guy’s Hospital has worked with patients to design a remote monitoring platform that enables regular tracking of patients’ symptoms over time, allowing more flexible and targeted care. The system means patients can also access support when needed most and at a time that suits them. Demonstrating measurable quality improvements from this innovation, the team won a BSR Best Practice Award in 2022.

    Best practice case study: North Bristol NHS Trust (Living Well)

    The North Bristol Trust (NBT) has implemented a ‘Living Well Pathway’ involving educational events to provide patients with information on self-management of chronic inflammatory arthritis or connective tissue conditions. As well improvements in patient engagement and levels of fatigue and depression, the Living Well Pathway is anticipated to have wider economic benefits for the Trust through fewer General Practitioner (GP) and consultant appointments, fewer Accident and Emergency (A&E) visits and reduced medication use and wastage.