Patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review of patient reported outcomes and patient and clinician satisfaction

Rebecca Whear, Abdul-Kareem Abdul-Rahman, Jo Thompson-Coon, Kate Boddy, Mark G Perry, Ken Stein, Rebecca Whear, Abdul-Kareem Abdul-Rahman, Jo Thompson-Coon, Kate Boddy, Mark G Perry, Ken Stein

Abstract

Background: The 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.

Methods: Seven 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.

Results: Seven 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).

Conclusions: The 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.

Figures

Figure 1
Figure 1
Identification and selection of studies for the review.
Figure 2
Figure 2
Characteristics of included studies.
Figure 3
Figure 3
Patient reported outcomes chart (breast cancer) [12,13].
Figure 4
Figure 4
Patient reported outcomes chart (IBD) [14-16].
Figure 5
Figure 5
Patient reported outcomes chart (RA) [17-20].
Figure 6
Figure 6
Patient and clinician satisfaction/acceptability [14-20].

References

    1. DoH. The Expert Patient: A New Approach to Chronic Disease Management for the 21st Century. London: Department of Health; 2001. p. 35.
    1. Hehir M, Hewlett S, Mitchell K, Kirwan J, Memel D, Pollock J. et al.What happens in RA outpatient clinics? Rheumatology. 2001;13:s146.
    1. EPP. Self care reduces costs and improves health - the evidence. London; 2010.
    1. DoH. Choose & Book – Patient’s Choice of Hospital and Booked Appointment. London: Department of Health; 2004. p. 16.
    1. HES. Outpatient data: SHA and provider level analysis 2008-09 and 2009-10. ONS: NHS Information Centre for Health and Social Care; 2010. .
    1. Rose KD, Ross JS, Horwitz LI. Advanced access scheduling outcomes a systematic review. Arch Intern Med. 2011;13(13):1150–1159. doi: 10.1001/archinternmed.2011.168.
    1. Robinson L, Chen R. A comparison of traditional and open-access policies for appointment scheduling. Manuf Serv Oper Manage. 2010;13(2):330–346.
    1. Liu N, Ziya S, Kulkarni VG. Dynamic scheduling of outpatient appointments under patient no-shows and cancellations. M Som-Manuf Serv Oper Manage. 2010;13(2):347–364.
    1. Nuffield. Health and Social Care Bill: Second reading, House of Lords. London: Nuffield Trust; 2011.
    1. CRD. Systematic Reviews: CRD’s guidance for undertaking reviews in healthcare. York: Centre for Reviews and Dissemination; 2009.
    1. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Guidance on the conduct of systematic reviews. London: Economic and Social Research Council; 2006.
    1. Brown L, Payne S, Royle G. Patient-initiated follow-up of breast cancer. Psychooncology. 2002;13(4):346–355. doi: 10.1002/pon.576.
    1. Sheppard C, Higgins B, Wise M, Yiangou C, Dubois D, Kilburn S. Breast cancer follow-up: a randomised controlled trial comparing point of need access versus routine 6-monthly clinical review. Eur J Oncol Nurs. 2009;13:2–8. doi: 10.1016/j.ejon.2008.11.005.
    1. Kennedy A, Nelson E, Reeves D, Richardson G, Roberts C, Robinson A. et al.A randomised controlled trial to assess the impact of a package comprising a patient-orientated, evidence-based self-help guidebook and patient-centered consultations on disease management and satisfaction in inflammatory bowel disease. Health Technol Assess. 2003;13(28)
    1. Robinson A, Thompson DG, Wilkin D, Roberts C, Grp NWGR. Guided self-management and patient-directed follow-up of ulcerative colitis: a randomised trial. Lancet. 2001;13(9286):976–81. doi: 10.1016/S0140-6736(01)06105-0.
    1. Williams JG, Cheung WY, Russell IT, Cohen DR, Longo M, Lervy B. Open access follow up for inflammatory bowel disease: pragmatic randomised trial and cost effectiveness study. Br Med J. 2000;13(7234):544–8. doi: 10.1136/bmj.320.7234.544.
    1. Kirwan JR, Mitchell K, Hewlett S, Hehir M, Pollock J, Memel D. et al.Clinical and psychological outcome from a randomized controlled trial of patient-initiated direct-access hospital follow-up for rheumatoid arthritis extended to 4 years. Rheumatology. 2003;13(3):422–6. doi: 10.1093/rheumatology/keg130.
    1. Hewlett S, Mitchell K, Haynes J, Paine T, Korendowych E, Kirwan JR. Patient-initiated hospital follow-up for rheumatoid arthritis. SO. Rheumatology (Oxford) 2000;13:990–997.
    1. Hewlett S, Kirwan J, Pollock J, Mitchell K, Hehir M, Blair PS. et al.Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial. BMJ. 2005;13(7484):171. doi: 10.1136/bmj.38265.493773.8F.
    1. Sands A, Adams N. A comparison of patient-initiated versus conventional follow-up for rheumatoid arthritis. J Pain Manage. 2009;13(4):391–400.
    1. Chattopadhyay C, Hickey PM. Are routine appointments cost-effective in modern rheumatology practice? A comparative outcome audit of routine follow-ups and patient initiated consultations. Arthritis Rheum. 2008;13(9):S885.
    1. NICE. Rheumatoid arthritis: The management of rheumatoid arthritis in adults. London: National Institute for Health and Clinical Excellence; 2009.
    1. Luqmani R, Hennell S, Estrach C, Basher D, Birrell F, Bosworth A. et al.British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years) Rheumatology. 2009;13(4):436–9. doi: 10.1093/rheumatology/ken450a.
    1. Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R. et al.Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;13:571–607. doi: 10.1136/gut.2010.224154.
    1. Polo D, Tipler S, Kirwan J, Hewlett S. Implementing a patient-led, nurse-supported service in a long-term condition. Nurs Times. 2005;13(49):28–31.
    1. Whear R, Abdul-Rahman A, Thompson-Coon J, Boddy K, Perry M, Stein K. The clinical effectiveness and resource use of patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review. Plos One. 2013;13(10) Epub e74774. doi:10.1371/journal.pone.0074774.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere