Evaluating the utility and impact of a patient-initiated follow-up pathway on service pressures in a tertiary neurogastroenterology clinic

Abstract

Objective Neurogastroenterology disorders, including disorders of gut-brain interaction (DGBI), are among the most encountered conditions in gastroenterology clinics, associated with high healthcare utilisation, compounding service and waiting list pressures. We implemented a patient-initiated follow-up pathway (PIFU) for selected patients at a neurogastroenterology clinic to understand if this was an effective and efficient way of managing waiting lists. Design In a tertiary setting with access to a multidisciplinary team, stable patients with neurogastroenterology disorders and DGBI were added to a time-limited PIFU on the understanding they would not receive routine clinic follow-up; instead, PIFU activation would trigger an appointment within ≤6 weeks. We evaluated outcomes of patients managed on PIFU between August 2021 and May 2025. Results 177 neurogastroenterology patients (mean age 50.3 years) were managed on a PIFU pathway after integrated care and a mean 3.7±2.3 tertiary appointments. Irritable bowel syndrome (IBS) (102/177, 57.6%) was the most common condition managed on PIFU (p=0.006) and 46/177 (26%) had DGBI overlap. After a mean of 475±SD 224.4 days on PIFU, only 11.3% (n=20/177) activated PIFU resulting in an estimated saving of £58 507 and 395 routine appointments. Compared with non-activators, there were no differences in patient characteristics except that PIFU activators were more likely to have DGBI overlap (p=0.02) and IBS activators were more likely to be antispasmodic non-responders (p=0.02). Conclusion PIFU can be used effectively in selected patients with DGBI responsive to first-line and second-line treatment. Routine follow-up should be reserved for more complex, refractory patients with more comorbidities and DGBI overlap.

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