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Published on: February 5, 2019
Evaluation of the need for follow-up in an out-patient clinic
A G Leitch1, S Parker, A Currie
1Royal Victoria Dispensary for Diseases of the Chest, Edinburgh, U.K.
Insights
Stable patients attending chest clinics can be discharged without impacting outcomes. This study reveals a reluctance among doctors and general practitioners to discharge stable patients, despite evidence supporting it.
Area of Science:
- Pulmonology
- Clinical Medicine
- Healthcare Management
Background:
- Stable patients regularly attending chest clinics often continue routine follow-up.
- Discharge criteria for stable patients are well-defined but rarely applied.
Purpose of the Study:
- To evaluate the outcomes of stable chest clinic patients randomized to different follow-up frequencies.
- To assess the feasibility and impact of discharging stable patients from routine clinic care.
Main Methods:
- 164 stable chest clinic patients were randomized to 3-monthly (follow-up) or annual (discharge) follow-up.
- Patient outcomes were assessed after 1 year via general practitioner questionnaires.
- Patient and clinician perceptions of follow-up frequency and condition were recorded.
Main Results:
- No significant differences in patient outcomes were observed between the follow-up and discharge groups after one year.
- The follow-up group experienced a statistically significant increase in deaths.
- Clinicians and general practitioners showed reluctance to discharge stable patients, despite favorable outcomes in the discharge group.
Conclusions:
- Stable chest clinic patients can be safely discharged from routine follow-up without adverse effects.
- A significant disconnect exists between objective patient stability and the perceived need for continued clinic attendance.
- Healthcare providers demonstrate a resistance to discharging stable patients, impacting resource allocation and patient experience.
Abstract:
We have identified 164 patients regularly attending a chest clinic whose condition had been defined as stable on the basis of clear-cut criteria. These patients were randomly allocated to either routine follow-up at 3 monthly intervals (the 'follow-up' group) or annual follow-up (the 'discharge' group). After 1 year, on the basis of a questionnaire sent to the patients' general practitioners, there were no significant differences in outcome between the two groups apart from a just-significant increase in deaths in the 'follow-up' group. Nevertheless, at the conclusion of the trial clinic doctors felt that only 45% of patients and general practitioners that only 27% of patients should be discharged from the clinic. At the conclusion of the study patients in the 'discharge' group were significantly more likely to feel that they had been attending too infrequently and that their condition had worsened, although the latter was not borne out by objective data. We suggest that all these patients could have been discharged from the clinic without any difference in outcome. This study highlights the reluctance of clinic doctors and general practitioners to consider and effect the discharge of stable patients from routine clinic attendance.
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