ACCESS TO TREATMENT AND QUALITY OF LIFE

A. Connor¹, S. Fletcher², R. Higgins^2
1The Green Nephrology Programme, Campaign for Greener Healthcare, Oxford/UNITED KINGDOM, ²Department Of Renal Medicine, University Hospital Coventry & Warwickshire, Coventry/UNITED KINGDOM

Body: Introduction Climate change is established as a major global health threat. However the provision of healthcare itself has a significant environmental impact. Patient and staff transport contributes 18% of the overall emissions (18.6 MtCO₂ per year) attributable to NHS England. Opportunities to reduce the carbon footprint of kidney care, which is likely to contribute disproportionately to overall NHS emissions, must be identified. Renal transplant recipients often travel long distances for low-added-value follow up consultations. There is a lack of scientific evidence, and national guidance, to support decisions about the optimal frequency and nature of the contact that such follow up should entail. Aim Driven by a desire to reduce unnecessary patient travel, and thereby reduce the carbon cost and inconvenience of consultations without compromising quality, our unit introduced a telephone consultation clinic to provide follow up to stable renal transplant recipients. Methods Since 2006, telephone follow up has been offered to patients at their physician's discretion. Most patients are well known to the department and all have demonstrated stable graft function. Patients receive quarterly clinic appointments, of which one remains a face-to-face consultation in their nearest renal clinic. Fifteen minute telephone consultations commence with the patient ringing the clinician at a pre-arranged time. Patients must be able to report their current weight and BP. Blood tests are undertaken beforehand in the manner used for face-to-face consultations; patients may attend their local family practice, the city-centre phlebotomy service, or local hospital. Although not currently utilised within this service, RenalPatientView – an existing patient empowerment tool - would compliment this service well. Within the NHS Payment by Results System, telephone appointments are reimbursed at a locally negotiable value. Results This expanding service now provides 350 appointments per year, facilitating follow up to 123 of the 360 patients with transplants of more than one years standing. Informal patient feedback suggests high levels of satisfaction, appreciation of the improved convenience and, importantly, increased empowerment (a key component to the successful management of any chronic disease). To date, only two patients have opted to return to face-to-face follow up. No serious untoward incidents relating to the service have been reported. We calculated the average return distance travelled to attend a face-to-face appointment (32.48km) using the postcodes of 28 patients consecutively attending the clinic and those of their nearest clinic. The National Transport Survey indicates that journeys of this length will be undertaken by car (82% of the time), bus (5%), train (6%) and other (7%) modalities. Applying DEFRA conversion factors of 0.20487 kgCO₂eq/km for an average car, 0.10462 kgCO₂eq/km for a bus, and 0.06113 kgCO₂eq/km for a train, the carbon saving attributable to the annual 350 consultations is 2011 kgCO₂eq [((82/100)*350)*32.48*0.20487] + [((5/100)*350)*32.48*0.10462] + [((6/100)*350)*32.48*0.06113]. Conclusion Renal transplant recipient follow up by quarterly telephone consultations and an annual face-to-face appointment appears to be safe, to engender patient empowerment and to improve access to healthcare, whilst reducing the carbon cost of the service. Efforts should be made to reduce potential barriers to the development of similar clinics in other centres. More formal patient and clinician evaluation is warranted.

Disclosure: All authors have declared no conflicts of interest.