Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational impact study

Hugh McLeod*, Gemma Heath, Elaine Cameron, Geoff Debelle, Carole Cummins

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objectives - In line with a national policy to move care ‘closer to home’, a specialist children's hospital in the National Health Service in England introduced consultant-led ‘satellite’ clinics to two community settings for general paediatric outpatient services. Objectives were to reduce non-attendance at appointments by providing care in more accessible locations and to create new physical clinic capacity. This study evaluated these satellite clinics to inform further development and identify lessons for stakeholders.
Methods - Impact of the satellite clinics was assessed by comparing community versus hospital-based clinics across the following measures: (1) non-attendance rates and associated factors (including patient characteristics and travel distance) using a logistic regression model; (2) percentage of appointments booked within local catchment area; (3) contribution to total clinic capacity; (4) time allocated to clinics and appointments; and (5) clinic efficiency, defined as the ratio of income to staff-related costs.
Results - Satellite clinics did not increase attendance beyond their contribution to shorter travel distance, which was associated with higher attendance. Children living in the most-deprived areas were 1.8 times more likely to miss appointments compared with those from least-deprived areas. The satellite clinics’ contribution to activity in catchment areas and to total capacity was small. However, one of the two satellite clinics was efficient compared with most hospital-based clinics.
Conclusions - Outpatient clinics were relocated in pragmatically chosen community settings using a ‘drag and drop’ service model. Such clinics have potential to improve access to specialist paediatric healthcare, but do not provide a panacea. Work is required to improve attendance as part of wider efforts to support vulnerable families. Satellite clinics highlight how improved management could contribute to better use of existing capacity.
Original languageEnglish
Pages (from-to)377-384
Number of pages8
JournalBMJ Quality and Safety
Volume24
Issue number6
Early online date10 Apr 2015
DOIs
Publication statusPublished - 18 May 2015

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Consultants
Ambulatory Care Facilities
Observational Studies
Appointments and Schedules
Pediatrics
Logistic Models
Community Hospital
National Health Programs
Ambulatory Care
England
Delivery of Health Care
Costs and Cost Analysis

Cite this

McLeod, Hugh ; Heath, Gemma ; Cameron, Elaine ; Debelle, Geoff ; Cummins, Carole. / Introducing consultant outpatient clinics to community settings to improve access to paediatrics : an observational impact study. In: BMJ Quality and Safety. 2015 ; Vol. 24, No. 6. pp. 377-384.
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Introducing consultant outpatient clinics to community settings to improve access to paediatrics : an observational impact study. / McLeod, Hugh; Heath, Gemma; Cameron, Elaine; Debelle, Geoff; Cummins, Carole.

In: BMJ Quality and Safety, Vol. 24, No. 6, 18.05.2015, p. 377-384.

Research output: Contribution to journalArticle

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AU - Heath, Gemma

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AU - Cummins, Carole

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