CARE OF PATIENTS WITH SELECTED HEALTH-PROBLEMS IN FUNDHOLDING PRACTICES IN SCOTLAND IN 1990 AND 1992 - NEEDS, PROCESS AND OUTCOME

Background. At the time of the introduction of fundholding, a number o f potential benefits and concerns about fundholding were debated. Aim. A study was undertaken to compare process and outcome of care in pati ents with different levels of physical, social and psychological need in 1990 and 1992 in six fundholding groups in Scotland. Method. Patien ts aged 16 years and over consulting with a range of marker conditions in 1990 and 1992 completed a pre-consultation health status questionn aire asking about physical, social and psychological problems, and a p ost-consultation satisfaction/enablement questionnaire asking about th eir ability to cope, and understand their illness. Main outcome measur es were consultation length and satisfaction/enablement score. Results . Of patients attending in the study period, 39% consulted for one or more marker condition. The proportion of patients reporting social pro blems rose between 1990 and 1992 for 11 out of 12 conditions. Overall, consultation lengths remained constant. Patients wanting to discuss s ocial problems had significantly longer consultations than those repor ting no social problems or problems they did not wish to discuss. The proportion of patients expressing enablement dropped for eight conditi ons and rose for four between 1990 and 1992. The decrease in the propo rtion expressing enablement remained after controlling for the rise in the percentage reporting social problems. Patients who had social pro blems they did not wish to discuss but a general health questionnaire score of five or more were the group reporting lowest enablement. Sign ificantly more patients with pain, skin problems and digestive problem s reported social problems and significantly fewer of them reported en ablement in 1992 compared with 1990. Patients with diabetes, angina, c hronic bronchitis and problems seeing fared relatively well over the s tudy period. Some patients with psychosocial problems fared poorly (th ey had relatively short consultations and were unlikely to express an ability to cope/understand their illness). Conclusion. The issue of wh ether benefits to some patient groups from recent health service chang es may be matched by disadvantage to other groups, for example those w ith clinical problems with no financial incentive to provide pro-activ e care or with psychosocial difficulties, is discussed.