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Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational
Hugh McLeod1, Gemma Heath2, Elaine Cameron3
1Health Economics Unit, University of Birmingham, Birmingham, UK.
Insights
Satellite clinics offering specialist paediatric outpatient services in the community did not significantly reduce non-attendance. While improving access and efficiency for some, further work is needed to support vulnerable families and optimize capacity.
Area of Science:
- Healthcare Management
- Paediatric Outpatient Services
- Health Services Research
Background:
- National Health Service (NHS) policy aims to deliver healthcare 'closer to home'.
- Specialist children's hospitals are exploring community-based satellite clinics for general paediatric outpatient services.
- Key objectives include reducing patient non-attendance and increasing clinic capacity.
Purpose of the Study:
- To evaluate the impact of consultant-led satellite clinics in community settings.
- To assess their effectiveness in reducing non-attendance and increasing capacity.
- To identify lessons for future development of community-based paediatric services.
Main Methods:
- Comparative analysis of community versus hospital-based clinics.
- Assessment of non-attendance rates, patient characteristics, and travel distance using logistic regression.
- Evaluation of appointment booking, clinic capacity, time allocation, and clinic efficiency (income to staff costs ratio).
Main Results:
- Satellite clinics did not significantly increase attendance rates beyond the benefit of reduced travel distance.
- Children from most-deprived areas were 1.8 times more likely to miss appointments.
- The contribution to overall activity and capacity was minimal, though one clinic demonstrated efficiency.
Conclusions:
- Community satellite clinics show potential for improving access to specialist paediatric care but are not a complete solution.
- Strategies are needed to improve attendance, particularly for vulnerable populations.
- Optimizing management of satellite clinics can enhance the use of existing healthcare capacity.
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.
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