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Integrated diagnostic pathway for patients referred with suspected OSA: a model for collaboration across the primary-secondary care interface

Devani, N; Aslan, T; Leske, F; Mansell, SK; Morgan, S; Mandal, S; (2020) Integrated diagnostic pathway for patients referred with suspected OSA: a model for collaboration across the primary-secondary care interface. BMJ Open Respiratory Research , 7 (1) , Article e000743. 10.1136/bmjresp-2020-000743. Green open access

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Abstract

BACKGROUND: Obstructive sleep apnoea (OSA) presents a major healthcare challenge with current UK data suggesting that only 22% of individuals have been diagnosed and treated. Promoting awareness and improving access to diagnostics are fundamental in addressing these missing cases and the recognised complications associated with untreated OSA. Diagnosis usually occurs in secondary care with data from our trust revealing long wait times to undertake tests, reach a diagnosis and start treatment. This places a considerable time and emotional burden on the patient and a financial and logistical burden on the hospital. METHODS: We introduced an integrated community-based pathway for the diagnosis of OSA. This comprised a monthly clinic run from within a local general practice (GP) supported by a 'virtual multidisciplinary team' run by the hospital specialist team. Prospective collection of process, outcome and patient satisfaction data was compared with traditional hospital-based pathway data collected retrospectively. SETTING: A central London teaching hospital and GPs within a local commissioning neighbourhood. RESULTS: Between January 2018 and February 2019, 70 were patients referred and managed along the community pathway. Compared with the hospital pathway, data demonstrated a significant reduction in the time taken: from referral to perform a sleep test (29 vs 181 days, p<0.0001), to make a diagnosis (40 vs 230 days, p<0.0001) and commence treatment (127 vs 267, p<0.0001). Patient satisfaction in the community pathway was higher across all domains (p<0.05), fewer hospital outpatient appointments were required and cost estimates suggested an overall saving of up to £290 could be achieved for each patient. CONCLUSION: An integrated community-based pathway results in more timely diagnosis of OSA within a local setting while maintaining specialist input from the hospital team. It is favoured by patients and can reduce unnecessary appointments in secondary care.

Type: Article
Title: Integrated diagnostic pathway for patients referred with suspected OSA: a model for collaboration across the primary-secondary care interface
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjresp-2020-000743
Publisher version: http://dx.doi.org/10.1136/bmjresp-2020-000743
Language: English
Additional information: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Keywords: sleep apnoea
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10120023
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