The University of Southampton
University of Southampton Institutional Repository

Evaluation of specialists' outreach clinics in general practice in England: Process and acceptability to patients, specialists, and general practitioners

Bowling, Ann, Stramer, Katia, Dickinson, Edward, Windsor, Joy and Bond, Matthew (1997) Evaluation of specialists' outreach clinics in general practice in England: Process and acceptability to patients, specialists, and general practitioners Journal of Epidemiology & Community Health, 51, (1), 52 - 61. (PMID:9135789).

Record type: Article

Abstract

Objectives - The wider study aimed to evaluate specialists) outreach clinics in relation to their costs, processes, and effectiveness, including patients' and professionals' attitudes. The data on processes and attitudes are presented here.

Design - Self administered questionnaires were drawn up for patients, their general practitioners (GPs) and specialists, and managers in the practice. Information was sought from hospital trusts. The study formed a pilot phase prior to a wider evaluation.

Setting - Nine outreach clinics in general practices in England, each with a hospital outpatient department as a control clinic were studied.

Subjects - The specialties included were ear, nose, and throat surgery; rheumatology; and gynaecology. The subjects were the patients who attended either the outreach clinics or hospital outpatients clinics during the study period, the outreach patients' GPs, the outreach patients' and outpatients' specialists, the managers in the practices, and the NHS trusts which employed the specialists.

Main outcome measures - Process items included waiting Lists, waiting times in clinics, number of follow up visits, investigations and procedures performed, treatment, health status, patients' and specialists' travelling times, and patients' and doctors' attitudes to, and satisfaction with, the clinic.

Results - There was no difference in the health status of patients in relation to the clinic site tie, outreach and hospital outpatients' clinics) at baseline, and all but one of the specialists said there were no differences in casemix between their outreach and outpatients' clinics. Patients preferred, and were more satisfied with, care in specialists' outreach clinics in general practice, in comparison with outpatients' clinics. The outreach clinics were rated as more convenient than outpatients) clinics in relation to journey times; those outreach patients in work lost less time away from work than outpatients' clinic patients due to the clinic attendance. Length of time on the waiting list was significantly reduced for gynaecology patients; waiting times in clinics were lower for outreach patients than outpatients across all specialties. In addition, outreach patients were more Likely to be first rather than follow up attenders; rheumatology outreach patients were more likely than hospital outpatients to receive therapy. GPs' referrals to hospital outpatients' clinics were greatly reduced by the availability of outreach clinics. Both specialists and GPs saw the main advantages of outreach clinics in relation to the greater convenience and better access to care for patients. Few of the specialists and GPs in the outreach practices held formal training and education sessions in the outreach clinic, although over half of the GPs felt that their skills/expertise had broadened as a result of the outreach clinic.

Conclusions - The processes of care (waiting times, patient satisfaction, convenience to patients, follow up attendances) were better in outreach than in outpatients' clinics. However, waiting Lists were only significantly reduced for gynaecology patients, despite both GPs and consultants reporting reduced waiting lists for patients as one of the main advantages of outreach. Whether these improvements merit the increased cost to the specialists (in terms of their increased travelling times and time spent away from their hospital base) and whether the development of what is, in effect, two standards of care between practices with and without outreach can be stemmed and the standard of care raised in all practices leg, by sharing outreach clinics between GPs in an area) remain the subject of debate. As the data were based on the pilot study, the results should be viewed with some caution, although statistical power was adequate for comparisons of sites if not specialties.

Full text not available from this repository.

More information

Published date: February 1997
Keywords: primary care, referrals, tomlinson, london
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 334772
URI: http://eprints.soton.ac.uk/id/eprint/334772
ISSN: 0143-005X
PURE UUID: c0636d33-efa6-4268-bee4-8faaf3cbfcbc

Catalogue record

Date deposited: 26 Mar 2012 14:23
Last modified: 18 Jul 2017 06:11

Export record

Contributors

Author: Ann Bowling
Author: Katia Stramer
Author: Edward Dickinson
Author: Joy Windsor
Author: Matthew Bond

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×