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Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational impact study
  1. Hugh McLeod1,
  2. Gemma Heath2,
  3. Elaine Cameron3,
  4. Geoff Debelle4,
  5. Carole Cummins5
  1. 1Health Economics Unit, University of Birmingham, Birmingham, UK
  2. 2School of Life and Health Sciences, Aston University, Birmingham, UK
  3. 3Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
  4. 4Department of General Paediatrics, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
  5. 5Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Hugh McLeod, Health Economics Unit, University of Birmingham, Public Health Building, Birmingham B15 2TT, UK; h.s.t.mcleod{at}bham.ac.uk

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.

  • Healthcare quality improvement
  • Health services research
  • Health policy
  • Paediatrics
  • Patient-centred care

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