Abstract
BackgroundThe cost to the NHS of missed or inappropriate hospital appointments is considerable. Alternative methods of appointment scheduling might be more flexible to patients’ needs without jeopardising health and service quality. The objective was to systematically review evidence of patient initiated clinics in secondary care on patient reported outcomes among patients with chronic/recurrent conditions.MethodsSeven databases were searched from inception to June 2013. Hand searching of included studies references was also conducted. Studies comparing the effects of patient initiated clinics with traditional consultant led clinics in secondary care for patients with long term chronic or recurrent diseases on health related quality of life and/or patient satisfaction were included. Data was extracted by one reviewer and checked by a second. Results were synthesised narratively.ResultsSeven studies were included in the review, these covered a total of 1,655 participants across three conditions: breast cancer, inflammatory bowel disease and rheumatoid arthritis. Quality of reporting was variable. Results showed no significant differences between the intervention and control groups for psychological and health related quality of life outcomes indicating no evidence of harm. Some patients reported significantly more satisfaction using patient-initiated clinics than usual care (p < 0.001).ConclusionsThe results show potential for patient initiated clinics to result in greater patient and clinician satisfaction. The patient-consultant relationship appeared to play an important part in patient satisfaction and should be considered an important area of future research as should the presence or absence of a guidebook to aid self-management. Patient initiated clinics fit the models of care suggested by policy makers and so further research into long term outcomes for patients and service use in this area of practice is both relevant and timely.
Highlights
The cost to the NHS of missed or inappropriate hospital appointments is considerable
Around 17.5 million people in Great Britain have a chronic condition [1]. Those who are managed in the secondary care setting attend hospital appointments initiated by a physician at regular intervals e.g. every six, nine or 12 months
Patient and clinician satisfaction was often significantly greater with Patient-initiated clinics (PIC) than with regular appointment scheduling for both Inflammatory bowel disease (IBD) and Rheumatoid Arthritis (RA)
Summary
The cost to the NHS of missed or inappropriate hospital appointments is considerable. Around 17.5 million people in Great Britain have a chronic condition [1] Those who are managed in the secondary care setting (some conditions are managed in primary care) attend hospital appointments initiated by a physician at regular intervals e.g. every six, nine or 12 months. Various initiatives have been introduced to promote appointment attendance or avoid unfilled appointments, for example, overbooking appointments, introducing fines for missed appointments and using alerts and reminders Whilst these systems may help to reduce the number of missed appointments (there were 6.7million missed appointments in 2009/10 reported to cost the National Health Service (NHS) millions of pounds every year) [5] they do not help to make appointment scheduling more responsive to the needs of the patient
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