OA21 Writing rheumatology outpatient clinic letters directly to patients: preferences, perspectives and support to change practice

Despite 2018 national guidance from the Academy of Medical Royal Colleges, most UK rheumatology healthcare professionals (HCPs) do not write outpatient clinic letters directly to patients. We aimed to understand patient preferences and HCP perspectives regarding rheumatology outpatient clinic letters, and the incentives, barriers and support required to change HCPs letter-writing practice.

We conducted surveys of adult rheumatology patients and HCPs, and used descriptive statistics to analyse the data. Participants were recruited via eight UK NHS sites, patient and professional organisations and networks, and social media. Online surveys were available for 12 weeks in 2024, with some in-person support at four sites. NHS ethical approval was gained.

619/705 (88%) patients, and 255/299 (85%) HCPs who began the survey, completed it. Patient participants were from a wide range of age groups; HCPs were of expected working age. Patients and HCPs were predominantly female (90%, 69% respectively) and white (92%, 76% respectively). HCPs included representation from all members of the rheumatology multi-disciplinary team. 64% of patients preferred letters to be written directly to them, but only 20% of HCPs do this in practice. 81% of patients felt ‘happy/very happy’ about letters containing a section for GPs, written in complex medical language. Only one patient reported not wanting to receive clinic letters. HCPs were asked whether writing to patients “improves patients’ understanding of what was discussed during the consultation”. 95% of those who write to patients agreed, compared with 61% who write directly to GPs. Regarding whether this practice “improves communication during the clinical consultation”, 79% of those who write to patients agreed, contrasted with 34% of those who write directly to GPs. When asked whether it “takes longer than writing to the GP”, 61% of those who write to patients disagree, compared with 16% of those who write directly to GPs. Among the 20% of HCP respondents who currently write directly to patients, key factors influencing uptake were policy (45%) and being inspired by peers (36%). 32% of HCPs who currently write to GPs are likely to try writing to patients in the next 12 months; 14% more indicated they would do so with support. The top forms of support required were: “Examples of other colleagues’ letters to patients”, “Information about patients’ perspectives” and “A glossary of rheumatology terms with definitions in plain English”.

This study demonstrates the strong desire from rheumatology patients for outpatient clinic letters to be written directly to them, which is not currently being met in practice. HCPs who write directly to patients, and those who do not, have different views about the impact and ease of doing so. Support is required for HCPs to change their practice and meet their expressed patients’ needs.

R. Goulding: None. J. Firth: None. W.J. Gregory: Consultancies; W.J.G has received honoraria for speaking and advisory board participation from Abbvie, Novartis, Pfizer, Sobi and UCB, unrelated to this project. K. Staniland: None. B. McMillan: None. E. MacPhie: None. W. Dixon: None. C.A. Sharp: None.