Evaluation of outreach clinics held by specialists in general practice in England

Objectives-To measure the processes of care, health benefits and costs of o utreach clinics held by hospital specialists in primary care settings. Design-The study was designed as a case-referent (comparative) study in whi ch the features of 19 outreach clinics (cases) were compared with matched o utpatient clinics (controls). The measuring instruments were self administe red questionnaires. Patients were followed up at six months to reassess hea lth status. The specialties included in the study were cardiology, ENT, gen eral medicine, general surgery, gynaecology and rheumatology. Setting-Specialist outreach clinics in general practice in England, with ma tched outpatient clinic controls. Subjects-Consecutive patient attenders in the outreach and outpatient clini cs, their specialists, the outreach patients' general practitioners, practi ce managers and trust accountants. Patients' response rate at baseline: 78% (1420). Main outcome measures-Patient satisfaction, doctors' attitudes, processes a nd health outcomes, costs. Results-Outreach patients were more satisfied with the processes of their c are than outpatients, their access to specialist care was better than that for outpatients and they were more likely to be discharged. Doctors reporte d that the main advantages of the outreach clinic were improved patient acc ess to specialists and convenience for patients, in comparison with outpati ents, and most GPs and specialists felt the outreach clinic was ('worthwhil e". At six month follow up, the health status of the outreach sample had si gnificantly improved more than that of the outpatients on all eight sub-sca les of the HSQ-12, but this was probably because of their better starting p oint at baseline. The impact of outreach on health outcomes was small. The NHS costs of outreach were significantly higher than outpatients. An increa se in outreach clinic size would reduce cost per patient, but would lead to the loss of most of the clinics' benefits. Conclusions-While the process of care was of higher quality in outreach tha n in outpatients, and the efficiency of care was also greater in the latter , the effect on patients' health outcomes was small. Responsiveness to pati ents' views and preferences is an essential component of good quality servi ce provision. However, the greater cost of outreach raises the issue of whe ther improvements in the quality and efficiency of health care, without a s ubstantial impact on health outcomes, is money well spent in a publicly fun ded health service. On the other hand, the real costs of outreach in compar ison with outpatients clinics can probably only be truly estimated in a lon gitudinal study with a resource based costing model derived from documented patient attendances and treatment costs over time in relation to longer te rm outcome (for example, at a two year end point).