Black M, Leese B, Gosden T, Mead N
National Primary Care Research and Development Centre, University of Manchester.
Br J Gen Pract. 1997 Sep;47(422):558-61.
Specialist outreach clinics in general practice, in which hospital-based specialists hold outpatient clinics in general practitioners' (GPs) surgeries, are one example of a shift in services from secondary to primary care.
To describe specialist outreach clinics held in fundholding general practices in two specialties from the perspective of patients, GPs, and consultants, and to estimate the comparative costs of these outreach clinics and equivalent hospital outpatient clinics.
Data were collected from single outreach sessions in fundholding practices and single outpatient clinics held by three dermatologists and three orthopaedic surgeons. Patients attending the outreach and outpatient clinics, GPs from practices in which the outreach clinics were held, and the consultants all completed questionnaires. Managers in general practice and hospital finance departments supplied data for the estimation of costs.
Initial patient questionnaires were completed by 83 (86%) outreach patients and 81 (75%) outpatients. The specialist outreach clinics sampled provided few opportunities for increased interaction between specialists and GPs. Specialists were concerned about the travelling time resulting from their involvement in outreach clinics. Waiting times for first appointments were shorter in some outreach clinics than in outpatient clinics. However, patients were less concerned about the location of their consultation with the specialist than they were about the interpersonal aspects of the consultation. There was some evidence of a difference in casemix between the dermatology patients seen at outreach and those seen at outpatient clinics, which confounded the comparison of total costs associated with the two types of clinic. However, when treatment and overhead costs were excluded, the marginal cost per patient was greater in outreach clinics than in hospital clinics for both specialties studied.
The study suggests that a cautious approach should be taken to further development of outreach clinics in the two specialties studied because the benefits of outreach clinics to patients, GPs and consultants may be modest, and their higher cost means that they are unlikely to be cost-effective.
全科医疗中的专科外展诊所，即医院专科医生在全科医生（GP）诊所开设门诊，是服务从二级医疗向初级医疗转变的一个例子。
从患者、全科医生和顾问的角度描述在两个专科的基金持有型全科医疗中举办的专科外展诊所，并估算这些外展诊所与同等医院门诊诊所的比较成本。
收集来自基金持有型诊所的单次外展诊疗以及三位皮肤科医生和三位骨科医生开设的单次门诊的数据。参加外展诊所和门诊的患者、举办外展诊所的诊所的全科医生以及顾问都完成了问卷调查。全科医疗和医院财务部门的管理人员提供了成本估算数据。
83名（86%）外展患者和81名（75%）门诊患者完成了初始患者问卷。抽样的专科外展诊所几乎没有为专科医生和全科医生增加互动提供机会。专科医生担心参与外展诊所带来的出行时间。一些外展诊所的首次预约等待时间比门诊诊所短。然而，患者对与专科医生会诊地点的关注低于对会诊人际方面的关注。有证据表明，外展诊所皮肤科患者与门诊诊所皮肤科患者的病例组合存在差异，这混淆了两种类型诊所相关总成本的比较。然而，当排除治疗和间接费用时，所研究的两个专科的外展诊所每位患者的边际成本都高于医院诊所。
该研究表明，对于所研究的两个专科的外展诊所的进一步发展应持谨慎态度，因为外展诊所对患者、全科医生和顾问的益处可能不大，而且其较高的成本意味着它们不太可能具有成本效益。
