Bowling, Ann and Bond, Matthew
A national evaluation of specialists' clinics in primary care settings
British Journal of General Practice, 51, (465), . (PMID:11458477).
Full text not available from this repository.
Background: Encouraged by the increased purchasing power of general(practitioners (GPs), specialist-run clinics in general practice and community health care settings (known as specialist outreach clinics) have increased rapidly across England. The activities of local commissioning schemes within primary care groups are likely to accelerate this bend.
Aim: To evaluate the costs processes, and benefits of specialists' outreach clinics held in GPs' surgeries compared with hospital outpatient clinics.Design of Study: A case-referent (comparative) study comparing the characteristics of outreach clinics (cases) with marched outpatient control clinics.Setting: Thirty-eight outreach clinics, compared with 38 matched outpatient clinics as controls covering 14 hospital trust areas across England
Method: Self-administered questionnaires were given to patients in both clinic settings. These covered processes, satisfaction, personal costs and health status, with postal follow-up at six months to assess health outcomes. Self-administered questionnaires were also gh en to the specialists and GPs whose clinics were included in the study (individual patient clinical sheet and an attitude questionnaire), practice managers, and hurt accountants (process and costs questionnaire). Evaluation of the costs, processes, and benefits of specialist outreach clinics versus hospital outpatient clinics was carried our by comparing questionnaire responses.Results: In comparison with outpatients outreach clinic patients spent less rime on the waiting lists for appointments to sec the specialist, they had shorter waiting times in clinics, fewer follow-up appointments, and were more likely to he completely discharged after the sampled attendance. Outreach patients were mure satisfied than outpatients with the range of clinic process items asked about. Most doctors felt that the outreach clinic was 'worthwhile'. While patients' personal costs were lower in outreach than in outpatients clinics, NHS costs were more expensive per patient in outreach. The benefits of outreach clinics on patients 'health status at six months' follow-up rr ere relatively small.
Conclusions: Outreach clinics are a means of improving access to specialist services for patients in addition to improving the efficiency and quality of health care. Most results were similar across specialties and areas. The benefits of the outreach sen ice need to be weighed against their substantially higher NHS costs, in comparison with outpatients clinics Outreach clinics are unlikely to financially justifiable for NHS funding given that the impact on patients' health status was small.
Actions (login required)