Gillam S J, Ball M, Prasad M, Dunne H, Cohen S, Vafidis G
Academic Department of Public Health, St Mary's Hospital Medical School, London.
Br J Gen Pract. 1995 Dec;45(401):649-52.
With the advent of general practitioner fundholding, there has been growth in outreach clinics covering many specialties. The benefits and costs of this model of service provision are unclear.
A pilot study aimed to evaluate an outreach model of ophthalmic care in terms of its impact on general practitioners, their use of secondary ophthalmology services, patients' views, and costs.
A prospective study, from April 1992 to March 1993, of the introduction of an ophthalmic outreach service in 17 general practices in London was undertaken. An ophthalmic outreach team, comprising an ophthalmic medical practitioner and an ophthalmic nurse, held clinics in the practices once a month. Referral rates to Edgware General Hospital ophthalmology outpatient department over one year from the study practices were compared with those from 17 control practices. General practitioners' assessments 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 conducted using self-administered structured questionnaires. A costings exercise compared the outreach model with the conventional hospital ophthalmology outpatient clinic.
Of 1309 patients seen by the outreach team in the study practices, 480 (37%) were referred to the ophthalmology outpatient department. The annual referral rate to this department 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 from control practices. An increase in knowledge of ophthalmology was reported by 18 of 47 general practitioners (38%). Nineteen (40%) of 47 general practitioners took 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 patients with cataracts or diabetes than those who did not attend for inservice training. The outreach scheme was popular with patients, for whom ease of access and familiarity of surroundings were major advantages. The cost per patient seen in the outreach clinics (48.09 pounds) was about three times the cost per patient seen in the outpatient department (15.71 pounds).
The model of ophthalmic outreach care in this pilot study was popular with patients and general practitioners and appeared to act as an effective filter of demand for care in the hospital setting. However, the educational impact of the scheme was limited. Although the unit costs (per patient) of the outreach scheme compared unfavourably with those of conventional outpatient treatment, potential health gains from this more accessible model of care require further exploration.
随着全科医生基金持有制的出现，涵盖多个专科的外展诊所数量有所增加。这种服务提供模式的益处和成本尚不清楚。
一项试点研究旨在评估眼科护理外展模式对全科医生、他们对二级眼科服务的使用、患者意见以及成本的影响。
于1992年4月至1993年3月在伦敦的17家全科诊所开展了一项前瞻性研究，引入眼科外展服务。一个由一名眼科医生和一名眼科护士组成的眼科外展团队每月在这些诊所举办一次门诊。将研究诊所一年内向埃奇韦尔综合医院眼科门诊部的转诊率与17家对照诊所的转诊率进行比较。通过对所有合伙人的邮政调查以及对每家诊所一名合伙人的访谈，征求全科医生对该计划及其对他们眼科知识和实践影响的评估。使用自行填写的结构化问卷进行患者调查。进行了成本核算，将外展模式与传统医院眼科门诊进行比较。
在外展团队在研究诊所诊治的1309名患者中，480名（37%）被转诊至眼科门诊部。对照诊所每年向该科室的转诊率为每10000名注册患者9.5例，而研究诊所为每10000名注册患者3.8例。对照诊所共有1187名患者被转诊至门诊部。47名全科医生中有18名（38%）报告眼科知识有所增加。47名全科医生中有19名（40%）利用了与外展团队一起参加在职培训的机会；与未参加在职培训的医生相比，他们更有可能改变白内障或糖尿病患者的眼科护理常规做法或转诊标准。外展计划受到患者欢迎，对患者来说，就医方便和环境熟悉是主要优点。外展诊所每名患者的成本（48.09英镑）约为门诊部每名患者成本（15.71英镑）的三倍。
本试点研究中的眼科外展护理模式受到患者和全科医生的欢迎，似乎是医院环境中护理需求的有效过滤器。然而，该计划的教育影响有限。尽管外展计划的单位成本（每名患者）与传统门诊治疗相比不利，但这种更容易获得的护理模式可能带来的健康益处需要进一步探索。
