ESPN 50th Annual Meeting

ESPN 2017


 
LOCAL VS. REGIONAL PATHWAY AND COST-IMPLICATIONS IN THE RENAL MONITORING AND MANAGEMENT OF HENOCH-SCHONLEIN PURPURA
RAJESH KANNAN VISWANATHAN 1 ERIN WOON 1 JASAVANTH BASAVARAJU 1

1- DEPARTMENT OF PAEDIATRICS, WHISTON HOSPITAL, WARRINGTON ROAD, PRESCOT L35 5DR
 
Introduction:

Henoch-Schönlein purpura (HSP) is an IgA mediated commonest systemic vasculitis with risk of long-term renal involvement. The regional pathway recommends a six-month nurse led follow-up with stratification of children into either Standard pathway(SP) or Proteinuria pathway(PP) at one week after presentation with PP cohort at increased risk of renal involvement. Our objectives were to compare our local practice management with regional pathway and study its cost implications. 

 

Material and methods:

A retrospective audit involving 50 consecutive children (33♂;17♀) diagnosed with HSP from 2011-14 formed the study cohort. The mean age at presentation was four years and one child was followed-up at a different organisation. At presentation blood pressure(BP) and urine analysis(UA) were undertaken in all 50 patients. 29 patients had normal UA and BP, 16 had abnormal UA and 4 had hypertension.  All 49 patients were evaluated at one week and sub-classified into SP (47) and PP (2), but additional 5 children in SP developed proteinuria during the study course.  

Results:

SP cohort had far more than recommended number of health professional(HP) reviews, UA and BP but at random/variable frequency. 
Majority of PP cohort missed the key intensive scheduled reviews. UA and BP was done at majority of the reviews but none had Primary investigations (urea and electrolytes, urine microscopy and urine protein creatinine ratio) potentially missing out on early identification of renal involvement. None of the seven patients in Proteinuria pathway developed any long-term renal sequelae. 
Altogether there were at least 171 HP reviews, and 15 inpatient admissions which were unwarranted and far more frequent UA monitoring. This created more anxiety/inconvenience amongst families and stretched HP resources. 
 

 

Conclusions:

We introduced a modified local nurse-led community pathway to standardize care, improve clinical care and cost-efficiency without compromising safety. Adherence to this would have resulted in estimated cost-savings of £48,000.