INVESTIGATION OF BENEFITS AND COSTS OF AN OPHTHALMIC OUTREACH CLINIC IN GENERAL-PRACTICE

Background. With the advent of general practitioner fund-holding, ther e has been growth in outreach clinics covering many specialties. The b enefits and costs of this model of service provision are unclear. Aim. A pilot study aimed to evaluate an outreach model of ophthalmic care in terms of its impact on general practitioners, their use of secondar y ophthalmology services, patients' views, and costs. Method. A prospe ctive study, from April 1992 to March 1993, of the introduction of an ophthalmic outreach service in 17 general practices in London was unde rtaken. An ophthalmic outreach team, comprising an ophthalmic medical practitioner and an ophthalmic nurse, held clinics in the practices on ce a month. Referral rates to Edgware General Hospital ophthalmology o utpatient department over one year from the study practices were compa red with those from 17 control practices. General practitioners' asses sments of the scheme and its impact on their knowledge and practice of ophthalmology were sought through a postal survey of all partners and interviews with one partner in each practice. Patient surveys were co nducted using self-administered structured questionnaires. A costings exercise compared the outreach model with the conventional hospital op hthalmology outpatient clinic. Results. Of 1309 patients seen by the o utreach team in the study practices, 480 (37%) were referred to the op hthalmology outpatient department The annual referral rate to this dep artment from control practices was 9.5 per 10 000 registered patients compared with 3.8 per 10 000 registered patients from study practices. A total of 1187 patients were referred to the outpatient department f rom control practices. An increase in knowledge of ophthalmology was r eported by 18 of 47 general practitioners (38%). Nineteen (40%) of 47 general practitioners rook advantage of the opportunity for inservice training with the outreach team, they were more likely to change their routine practice for ophthalmic care or referral criteria for patient s with cataracts or diabetes than those who did not attend for inservi ce training. The outreach scheme was popular with patients, for whom e ase of access and familiarity of surroundings were major advantages. T he cost per patient seen in the outreach clinics (pound 48.09) was abo ut three times the cost per patient seen in the outpatient department (pound 15.71). Conclusion. The model of ophthalmic outreach care in th is pilot study was popular with patients and general practitioners and appeared to act as an effective filter of demand for care in the hosp ital setting. However, the educational impact of the scheme was limite d. Although the unit costs (per patient) of the outreach scheme compar ed unfavourably with those of conventional outpatient treatment, poten tial health gains from this more accessible model of care require furt her exploration.