Introduction: The HTC in Nottingham was set up in 2013. Patients are referred to HTC from their first appointment with the Endocrinologist for regular follow up, as per national guidelines. Each Patient is reviewed by a Band 6 Nurse or Endocrine CNS, & counter-checked by an Endocrinologist in clinic.
There were two aims to this audit:
1. Assess patient satisfaction through a questionnaire (with an aim to capture 1/3 of HTC patients, if possible);
2. Assess clinical quality and effectiveness by reviewing clinical outcomes.
Methodology: Between May and September 2016, retrospective HTC patients were identified from their notes by Gateway staff and given an anonymous questionnaire to complete. The questionnaire was then given back to the Gateway staff and placed into an envelope. Each questionnaire had 17 questions and space for general comments.
May 2016 clinic lists were reviewed for patient outcomes, compliance and a cost analysis.
N = 79/350 (23%);
An overall positive response was classed as >90%;
13/17 questions received a positive response over 90%;
100% said they would use HTC again;
May October = 785 HTC patients, saving £14,718 in Consultant appointments;
Average follow up/patient = 12 weeks.
May 2016 HTC List Outcomes:
114 patients listed in 12 HTC sessions 25% male, 75% female.
21% had anti-thyroid medication dose titrated;
4% were discharged to GP;
2% stopped their anti-thyroid treatment due to side effects;
1% had a drop in neutrophil count to 1.4 (27.5);
35% remained on the same dose of anti-thyroid medication.
27% failed to have bloods pre HTC.
Conclusions: Overall patient satisfaction of HTC is excellent; there was a high DNA rate for blood tests before appointments; HTC is cheaper than a clinic appointment and an effective way to follow up thyroid patients regularly, within national guidelines.
Future Plans: Reduce slot time from 20 minutes to 15 minutes; CNS Nurse Prescriber to oversee each HTC follow up instead of Consultant; reduce DNA rate (Text reminders?); repeat audit in 12 months.