The efficiency of specialist outreach clinics in general practice: is further evaluation needed?

Abstract

To assess the need for further evaluation of general practice-based outreach clinics in two specialties using data from a UK pilot study to model their cost-effectiveness. A pilot study was undertaken comparing one outreach and one outpatient clinic held by three dermatology specialists and three orthopaedic specialists. Information was collected on waiting times, costs to patients, casemix and resource use. Only dermatology outreach clinic patients experienced significantly shorter waiting times for first appointments than their hospital counterparts. Outreach clinic patients incurred lower costs in attending appointments in either specialty but the differences were not statistically significant. Evidence of a difference in casemix between patients attending outreach and outpatient clinics meant that treatment costs incurred in both types of clinic could not be compared. Outreach clinics in both specialties were significantly more costly in terms of staff, staff travel and associated opportunity costs compared with outpatient clinics. Sensitivity analysis showed that outreach and outpatient clinics had the same marginal cost if the number of patients per outreach clinic increased greatly or attendance fell considerably at outpatient clinics. This study has found no evidence that outreach clinics in these two specialties are cost-effective in terms of costs and benefits. A more definitive conclusion could only be made if studies estimated other costs and benefits not accounted for in this study. Further research is required to see whether outreach clinics in other specialties or clinics with different configurations to those studied are efficient.