Evaluation of specialists' outreach clinics in general practice in England: process and acceptability to patients, specialists, and general practitioners.
نویسندگان
چکیده
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 (ie, 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 (eg, 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.
منابع مشابه
A national evaluation of specialists' clinics in primary care settings.
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 trend. AIM To evaluate the costs, processes, and...
متن کاملEvaluation of outreach clinics held by specialists in general practice in England.
OBJECTIVES To measure the processes of care, health benefits and costs of outreach clinics held by hospital specialists in primary care settings. DESIGN The study was designed as a case-referent (comparative) study in which the features of 19 outreach clinics (cases) were compared with matched outpatient clinics (controls). The measuring instruments were self administered questionnaires. Pati...
متن کاملSpecialist outreach clinics in general practice: what do they offer?
BACKGROUND Specialist outreach clinics in general practice, in which hospital-based specialists hold outpatient clinics in general practitioners' (GPs) surgeries, are one example of a shift in services from secondary to primary care. AIM To describe specialist outreach clinics held in fundholding general practices in two specialties from the perspective of patients, GPs, and consultants, and ...
متن کاملThe Frequency Distribution of Chief Complaints in Patients with Major Depressive Disorder Referring to Psychiatric Clinics in Kerman
Introduction: Physical symptoms associated with depression and common psychiatric disorders sometimes lead to the misdiagnosis of depressive disorders. The aim of this study was to determine the frequency distribution of different chief complaints in patients with major depressive disorder referring to psychiatric clinics according to their demographic characteristics and source of referral. Me...
متن کاملPrescribing pattern and Drug indicators in Patients Visited by General Practitioners and Specialists in Ardabil City of Iran
Drug is an important and strategic commodity and a basic need of the people in all countries. The aim of this study is to determine the drug use patterns and descriptive analysis of prescriptions of doctors in Ardabil city of Iran. A retrospective study was carried out on 2000 randomly-selected prescriptions. Data were obtained on demographics, prescribing indexes and analyzed by descriptive st...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Journal of epidemiology and community health
دوره 51 1 شماره
صفحات -
تاریخ انتشار 1997