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SPECIALIST YOUNG ADULT SUPPORT IMPROVES CLINIC ATTENDANCE
RATES AND DECREASES LEVELS OF HOSPITAL ADMISSIONS
Tomlin, M1&2, Coyne, E¹, Hope, W3, Bebb, C¹, Johnson, C2, Byrne, C¹
¹Nottingham University Hospitals NHS Trust, ²Derby Hospitals NHS Foundation Trust,
3
East Midlands Renal Network
INTRODUCTION: Young adults (aged 18-25) with Chronic Kidney Disease (CKD) have
been identified as a vulnerable group for poor treatment outcomes. This project, initially funded
by NHS Kidney Care, was set up to explore new and innovative ways to support this group. The
project provides one-to-one practical and emotional support on a wide range of health and social
areas to help improve young adult’s outcomes.
AIMS: Audit data were collected to assess the impact on clinic attendance rates and levels of
hospitals admissions within this patient group, since the start of the project.
DESIGN: Audit data were collected from patient information programs on an annual basis.
This included both demographic and treatment data. Patients involved were young adults (aged
18-25) living with CKD stages 3-5 (including those on renal replacement therapy), who were
under adult nephrology care at either of the hospital trusts involved in the project on 31st
December 2010. Baseline data were collected for 12 months prior to the project. Data have
since been collected at years 1 and 2.
FINDINGS: Baseline data were collected on 80 patients. 50% were male, 90% (72) were from
a white ethnic background, and 66% (53) of patients had transitioned from paediatric services.
At baseline, most patients had a functioning transplant (41%(33)), 35%(28) were CKD3-5, and
24%(19) were on dialysis. The home therapy uptake rate was 21%. Year 2 data was collected on
75 patients (4 CKD3 patients were discharged to the GP for renal care, one young adult passed
away). At this stage, 47%(35) had a functioning transplant, 28%(21) were on dialysis, and
25%(19) were CKD 3-5. The home therapy rate was 43%.
Baseline data showed a population clinic non-attendance rate of 22.1%, in year 2 this rate
reduced to 15.4% (year 1 rate = 14.3%). The median clinic non-attendance rate at baseline was
12.1%(0-100%), at year 2 it was 0%(0-100%). Males experienced higher clinic non-attendance
rates than females at baseline and year 2. The population clinic non-attendance rate fell for all
treatment modalities between baseline and year 2.
Baseline data showed 98 admissions within this group (416 bed days). This reduced to 75
admissions (333 bed days) in year 1, and reduced further to 48 admissions (197 bed days) in
year 2. The average length of stay reduced from 4.3 days to 4.1 days between baseline and year
2. Admissions linked to non-concordance with treatment fell from 24(89 bed days) to 7(24 bed
days) between baseline and year 2, and re-admissions within 28 days fell from 29 to 12.
CONCLUSION: Baseline data showed high levels of clinic non-attendance and avoidable
hospital admissions within this group. Subsequent data collection has shown that since the set
up of this project, clinic non-attendance rates and hospital admission rates have fallen.
Admissions linked to non-concordance with treatment have fallen each year that the project has
been operational. These reduced admissions and improved clinic attendance rates have resulted
in improved health and social outcomes for young adults, whilst also providing financial
savings to the NHS. These data show the positive impact that specialist young adult support can
have on this group to improve their treatment outcomes.