Cataract surgery in a community hospital outreach clinic: patients' costs and satisfaction

A cataract day surgery service for the Population of central Norfolk, UK, w as provided by the main ophthalmic department in a district general hospita l and in an outreach clinic in a community hospital 40 km distant. The outr each clinic aimed to extend the accessibility of this particular service in a rural area where many patients raced long journeys to the main hospital. Samples of 201 patients attending the main hospital for day cataract surge ry and 198 patients attending the outreach clinic for the same procedure we re identified. Patients were interviewed and given questionnaire forms to e stablish their general health before the operation, their arrangements to g et to hospital and their satisfaction with the clinic and the care they had received. The sample of patients attending the outreach clinic was slightl y older, less affluent and in slightly poorer general health than the patie nts attending the main hospital. The two samples were similar in terms of v isual acuity after the operation, complication rates, satisfaction with the outcome of the operation and subsequent use of health services. The journe y to hospital was quicker, more convenient and less costly for the outreach clinic patients than the main hospital patients. The net benefit to patien ts of the outreach clinic was estimated as pound 39.000 per annum. Satisfac tion with administrative matters, facilities at the two clinics and the car e received was high in both samples., but patients were significantly more satisfied with arrangements at the smaller outreach clinic. This evidence s uggests that an outreach clinic in a small community hospital can provide c ataract day surgery under local anaesthesia as effectively as a district ce ntre, at a reduced social cost and with positive social benefits. Further s tudy of heath service costs is vital, but political pressure to acknowledge patient preferences for more local services is growing. (C) 2001 Elsevier Science Ltd. All rights reserved.