GENERAL-PRACTITIONERS USE OF HOSPITAL AND COMMUNITY-BASED PEDIATRIC OUTPATIENT SERVICES IN NOTTINGHAM

The paper compares and contrasts the referral patterns of general prac titioners in Nottingham for paediatric specialist opinion in a hospita l and community setting. Data were collected from case notes review an d medical activity data returns on 100 consecutive referrals made by G Ps to a hospital paediatric consultant out-patient clinical and 100 co nsecutive referrals to a community based consultant clinic. Multiple d iagnoses are more commonly made and recorded by community based paedia tricians with a bias towards behavioural, nutrition, growth and neurod evelopmental problems. Hospital clinic staff made more system and dise ase based diagnoses with more investigations arranged than the communi ty staff [53 cf. 15 (OR 6.39, 95% CI; 3.25-12.55, P=<0.0001)]. More ch ildren under five were seen in the community clinic sample compared to the hospital sample [75 cf. 57 under fives (OR 2.26, 95% CI; 1.24-4.1 3, P=0.01)]. Patients are more likely to be discharged from the hospit al clinic than the community clinic after the initial visit. [59 cf. 3 3 (OR 2.92, 95% CI; 1.64-5.20, P=0.0004)]. Costs per new case consulta tion were substantially less in the community clinic than the hospital setting. A broadly similar range of clinic problems are referred to b oth hospital and community based paediatricians in Nottingham. The edu cational and liaison value of local community paediatric clinics toget her with relatively easier access by parents and lower per case costs is an advantage. Commissioners of paediatric and child health services need to take into consideration these factors when purchasing out-pat ient specialist paediatric opinion. Further research is required into the quality and desirability of these developments.