Article type
Year
Abstract
Objective: (i) There will be an improvement in the clinical and psychological outcome, (ii) GPs, patients and multidisciplinary teams will find the service more satisfactory, (iii) overall use of health care resources will be reduced.
Methods: 200 patients were randomised to routine 4-6 monthly review, or an "open" hospital appointment supported by access to a helpline via which they can obtain advice or an outpatient appointment within 2-4 weeks. To ensure these patients did not deteriorate without asking for help a safety net system was set up, consisting of 3 monthly questionnaires (measuring pain, disease activity, disability and work status). Any patients with significant deterioration who had not contacted the helpline were contacted by phone.
Results: At the end of the first year of shared care follow-up there have been 90 self referrals seen within a mean 4.9 working days (range 1-13 days) for a mean consultation time of 30 minutes. This contrasts with the routine clinic where 260 patients would have been seen, mean consultation time of 15 minutes. Almost all consultations were considered appropriate by the Rheumatologist. The safety net was failed on 75 out of 297 occasions but 55 (73%) of these patients had already asked for medical help; 10 (13%) denied they needed any help, and only 10 (13%) were advised to see their GP or offered a hospital review.
Discussion: Patients offered open access to outpatient facilities were seen infrequently but rapidly on request. Patient consultation time was longer and they used self referral appropriately, although there remains a small risk that a small percentage of patients may not ask for help when needed. Patient and Health Care Professional satisfaction has not yet been analysed, although verbal comments have suggested there is a higher degree of satisfaction within the shared care system.
Methods: 200 patients were randomised to routine 4-6 monthly review, or an "open" hospital appointment supported by access to a helpline via which they can obtain advice or an outpatient appointment within 2-4 weeks. To ensure these patients did not deteriorate without asking for help a safety net system was set up, consisting of 3 monthly questionnaires (measuring pain, disease activity, disability and work status). Any patients with significant deterioration who had not contacted the helpline were contacted by phone.
Results: At the end of the first year of shared care follow-up there have been 90 self referrals seen within a mean 4.9 working days (range 1-13 days) for a mean consultation time of 30 minutes. This contrasts with the routine clinic where 260 patients would have been seen, mean consultation time of 15 minutes. Almost all consultations were considered appropriate by the Rheumatologist. The safety net was failed on 75 out of 297 occasions but 55 (73%) of these patients had already asked for medical help; 10 (13%) denied they needed any help, and only 10 (13%) were advised to see their GP or offered a hospital review.
Discussion: Patients offered open access to outpatient facilities were seen infrequently but rapidly on request. Patient consultation time was longer and they used self referral appropriately, although there remains a small risk that a small percentage of patients may not ask for help when needed. Patient and Health Care Professional satisfaction has not yet been analysed, although verbal comments have suggested there is a higher degree of satisfaction within the shared care system.