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Multi-site evaluation of advanced practice hand therapy clinics for the management of patients with trigger digit

      Highlights

      • 67% of patients with TD diverted from the SOPD and treated in APHT improved sufficiently to allow discharge from the SOPD without specialist surgical consultation.
      • Only 1.4% of patients discharged from APHT were re-referred for the same condition in the following 12 months.
      • Superior initial Michigan hand questionnaire scores were associated with discharge from APHT without need for surgical review.
      • 88% of patients returned to SOPD were booked for surgery demonstrating high levels of agreement between surgeons and APHT regarding need for surgery.

      Abstract

      Study Design

      Prospective cohort design.

      Background

      Patient time on Australian public hospital surgical outpatient department (SOPD) waitlists often exceeds clinical recommendations for chronic hand conditions. Diversion to allied health is an alternative option, however evidence regarding patient and organizational outcomes in hand therapy is lacking.

      Purpose of the Study

      To evaluate clinical and organizational efficacy, patient outcomes and satisfaction of diversion of referrals for patients with trigger digit (TD) from SOPD waitlists to Advanced Practice Hand Therapy (APHT) at 3 Australian hospitals.

      Methods

      Data was collected from eligible patients with TD through chart reviews and telephone satisfaction surveys. Data included number of patients requiring SOPD review, repeat referral to SOPD in the 12 months following APHT discharge, patient-rated outcomes, satisfaction scores, wait times to SOPD review and conversion to surgery-rates. Mann Whitney-U, t-test, Pearson's chi-squared test and a Binary Logistic Regression analysis were performed.

      Results

      104 patients completed APHT treatment. Seventy patients (67%) did not require return to the SOPD waitlist. Repeat referral to SOPD within 12 months of APHT discharge occurred for only 1 patient. Patients requiring SOPD review after APHT treatment were seen within target time frames and demonstrated 88% conversion to surgery-rates. Michigan Hand Outcome Questionnaire scores showed greater improvement in those not requiring SOPD review (P< .001~25.9 vs 4.2). Regression analysis identified a negative association between initial total Michigan Hand Outcome Questionnaire scores and unfavorable discharge outcomes (OR 0.96, P= .007). Most (81%-93%) patients indicated satisfaction with the APHT service.

      Conclusion

      Diversion of referrals for TD from SOPD to APHT is an effective waitlist management strategy, with the propensity to reduce waiting times, improve patient flow, whilst resulting in favorable clinical and patient-rated outcomes and satisfaction.

      Keywords

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