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Service development II
PTU-245 Community based specialist gastroenterology clinic in Sheffield, UK—comparing primary care and secondary care based clinics 2010–2011
  1. L Strettle,
  2. A Abdulrehman,
  3. M E Sloan,
  4. M E McAlindon,
  5. A J Lobo
  1. Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

Abstract

Introduction Community based clinics may improve patients' access to healthcare and improve communication between primary and secondary care.1 A community gastroenterology clinic was established in Sheffield in 2011 to deliver out-patient care closer to patients' homes while retaining access to specialist expertise. This study reports results from the first 8 months of the community clinic and compares with secondary care gastroenterology clinics.

Methods A single, weekly, consultant-delivered new patient community clinic (CC), designed as a “one touch”, single consultation, was established in primary care for a Consortium of 27 General Practices. Data for the study period, March 2011–October 2011, was retrieved for the CC from referral proformas, letters and primary care records. This was compared to secondary care clinics for patients' referred from the same consortium during the study period and for the same time period the year prior to the CC (March 2010 to October 2010).

Results In March–October 2010, 579 patients from the consortium were seen in secondary care gastroenterology clinics. During March–October 2011, 896 patients were seen in gastroenterology clinics: 741 (82%) in secondary care and 155 (18%) in the newly established CC. Mean age was lower in the CC (50 vs 57.8 years, p<0.001), with 42/155 (27%) aged over 65 in the CC compared to 310/741 (42%) in the secondary care clinic (p<0.01). 67/741 (9.0%) patients did not attend appointments at the secondary care clinic compared to 9/155 (5.8%; p=0.15) in the CC. Median waits for CC appointments was 21 days at month 1 rising to 47.5 days in month 8. Presenting features were altered bowel habit (n=59 (38%)), abdominal pain (n=23 (15%)), reflux type dyspepsia (n=18 (12%)) and iron deficiency anaemia (n=16 (10%)). 144 patients (93%) attending the CC had had the specified pre-clinic investigations. 118/146 (81%) patients attending the CC were discharged back to the GP after one visit: of whom 111 (94%) had further tests recommended (33 blood tests, 56 gastroscopy, 53 colonoscopy, 16 ultrasound abdomen). In the 2010 period prior to the CC, 35/579 (6%) patients seen were discharged from their initial secondary care clinic review (p<0.0001).

Conclusion The new primary care gastroenterology clinic is associated with higher initial discharge rates, moving co-ordination of ongoing out-patient management to primary care. However, this was not associated with a reduction in patients seen in secondary care and attracted a younger cohort of patients. Additional follow-up is required to assess effects on overall healthcare resource utilisation.

Competing interests None declared.

Reference 1. Powell J. Systematic review of outreach clinics in primary care in the UK. J Health Serv Res Policy 2002;7:177–83.

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