Haynes R, Gale S, Mugford M, Davies P
School of Health Policy and Practice, University of East Anglia, Norwich, UK.
Soc Sci Med. 2001 Dec;53(12):1631-40. doi: 10.1016/s0277-9536(00)00448-2.
A cataract day surgery service for the population of central Norfolk, UK, was provided by the main ophthalmic department in a district general hospital and in an outreach clinic in a community hospital 40 km distant. The outreach clinic aimed to extend the accessibility of this particular service in a rural area where many patients faced long journeys to the main hospital. Samples of 201 patients attending the main hospital for day cataract surgery and 198 patients attending the outreach clinic for the same procedure were identified. Patients were interviewed and given questionnaire forms to establish their general health before the operation, their arrangements to get to hospital and their satisfaction with the clinic and the care they had received. The sample of patients attending the outreach clinic was slightly older, less affluent and in slightly poorer general health than the patients attending the main hospital. The two samples were similar in terms of visual acuity after the operation, complication rates, satisfaction with the outcome of the operation and subsequent use of health services. The journey to hospital was quicker, more convenient and less costly for the outreach clinic patients than the main hospital patients. The net benefit to patients of the outreach clinic was estimated as pounds sterling 39,000 per annum. Satisfaction with administrative matters, facilities at the two clinics and the care received was high in both samples, but patients were significantly more satisfied with arrangements at the smaller outreach clinic. This evidence suggests that an outreach clinic in a small community hospital can provide cataract day surgery under local anaesthesia as effectively as a district centre, at a reduced social cost and with positive social benefits. Further study of heath service costs is vital, but political pressure to acknowledge patient preferences for more local services is growing.
英国诺福克郡中部地区的白内障日间手术服务由一家地区综合医院的主要眼科部门以及距离该医院40公里的一家社区医院的外展诊所提供。外展诊所旨在扩大这项特殊服务在农村地区的可及性，该地区许多患者前往主要医院需要长途跋涉。研究确定了201名前往主要医院进行白内障日间手术的患者样本以及198名前往外展诊所进行相同手术的患者样本。对患者进行了访谈，并给他们发放了问卷，以了解他们手术前的总体健康状况、前往医院的安排以及他们对诊所和所接受护理的满意度。与前往主要医院的患者相比，前往外展诊所的患者样本年龄稍大、经济状况稍差且总体健康状况稍差。两组样本在术后视力、并发症发生率、对手术结果的满意度以及后续医疗服务使用方面相似。与前往主要医院的患者相比，前往外展诊所的患者前往医院的路程更快、更方便且成本更低。外展诊所每年给患者带来的净收益估计为39,000英镑。两组样本对行政事务、两家诊所的设施以及所接受护理的满意度都很高，但患者对规模较小的外展诊所的安排明显更满意。这一证据表明，小型社区医院的外展诊所能够像地区中心一样有效地提供局部麻醉下的白内障日间手术，同时降低社会成本并带来积极的社会效益。对医疗服务成本进行进一步研究至关重要，但承认患者对更多本地服务的偏好的政治压力也在不断增加。
