Abstract
A cohort of 392 patients referred to six outpatient clinics by general practitioners during 1987 with diagnoses of rheumatoid arthritis, osteoarthritis, peripheral vascular disease, psoriasis or eczema, were studied from the time of their first attendance until up to two years later. Six consultant clinics were studied in the three specialties: rheumatology, vascular surgery and dermatology. For each specialty a clinic in both a teaching hospital and a district general hospital were included. The cohort members were predominantly middle-aged or elderly people, with a greater proportion of women, except at the vascular surgery clinic where 65% of patients were men. The 392 patients made a total of 936 visits (median two, range one-eight) during the study period; 91 patients were still attending up to two years after the first visit. Patients referred by their general practitioner for therapy were less likely to be discharged than those referred for other reasons. The principal reason for continuing attendance as perceived by patients, general practitioners and hospital doctors was the necessity for consultant supervision, although agreement was far from complete in individual cases. Junior staff tended to see a higher proportion of patients at follow-up visits than did consultants, and were found to have lower discharge rates than consultants. Analyses of data showed that at the first visit, diagnosis, disease severity and the grade of doctor seeing the patient in the clinic was significantly associated with patient discharge at the P < 0.05 level of significance. Patients considered that their visits had produced improvement in their condition in 38% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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- Black D. The paradox of medical care. J R Coll Physicians Lond. 1979 Apr;13(2):57–65. [PMC free article] [PubMed] [Google Scholar]
- Bulpitt C. J., Daymond M. J., Dollery C. T. Community care compared with hospital outpatient care for hypertensive patients. Br Med J (Clin Res Ed) 1982 Feb 20;284(6315):554–556. doi: 10.1136/bmj.284.6315.554. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cochrane J. P., Williams J. T., Faber R. G., Slack W. W. Value of outpatient follow-up after curative surgery for carcinoma of the large bowel. Br Med J. 1980 Mar 1;280(6214):593–595. doi: 10.1136/bmj.280.6214.593. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cummins R. O., Jarman B., White P. M. Do general practitioners have different "referral thresholds"? Br Med J (Clin Res Ed) 1981 Mar 28;282(6269):1037–1039. doi: 10.1136/bmj.282.6269.1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Degoulet P., Menard J., Vu H. A., Golmard J. L., Devries C., Chatellier G., Plouin P. F. Factors predictive of attendance at clinic and blood pressure control in hypertensive patients. Br Med J (Clin Res Ed) 1983 Jul 9;287(6385):88–93. doi: 10.1136/bmj.287.6385.88. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dornan C., Fowler G., Mann J. I., Markus A., Thorogood M. A community study of diabetes in Oxfordshire. J R Coll Gen Pract. 1983 Mar;33(248):151–155. [PMC free article] [PubMed] [Google Scholar]
- Finlay A. Y., Kelly S. E. Psoriasis--an index of disability. Clin Exp Dermatol. 1987 Jan;12(1):8–11. doi: 10.1111/j.1365-2230.1987.tb01844.x. [DOI] [PubMed] [Google Scholar]
- Fraser R. C., Patterson H. R., Peacock E. Referrals to hospitals in an East Midlands city--a medical audit. J R Coll Gen Pract. 1974 May;24(142):304-14, 319. [PMC free article] [PubMed] [Google Scholar]
- Fries J. F., Spitz P., Kraines R. G., Holman H. R. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. doi: 10.1002/art.1780230202. [DOI] [PubMed] [Google Scholar]
- Glenn J. K., Hofmeister R. W., Neikirk H., Wright H. Continuity of care in the referral process: an analysis of family physicians' expectations of consultants. J Fam Pract. 1983 Feb;16(2):329–334. [PubMed] [Google Scholar]
- Grace J. F., Armstrong D. Reasons for referral to hospital: extent of agreement between the perceptions of patients, general practitioners and consultants. Fam Pract. 1986 Sep;3(3):143–147. doi: 10.1093/fampra/3.3.143. [DOI] [PubMed] [Google Scholar]
- Grace J. F., Armstrong D. Referral to hospital: perceptions of patients, general practitioners and consultants about necessity and suitability of referral. Fam Pract. 1987 Sep;4(3):170–175. doi: 10.1093/fampra/4.3.170. [DOI] [PubMed] [Google Scholar]
- Harding J. Study of discharge communications from hospital doctors to an inner London general practice. J R Coll Gen Pract. 1987 Nov;37(304):494–495. [PMC free article] [PubMed] [Google Scholar]
- Hull F. M., Westerman R. F. Referral to medical outpatients department at teaching hospitals in Birmingham and Amsterdam. Br Med J (Clin Res Ed) 1986 Aug 2;293(6542):311–314. doi: 10.1136/bmj.293.6542.311. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kiff R. S., Sykes P. A. Who undertakes the consultations in the outpatient department? Br Med J (Clin Res Ed) 1988 May 28;296(6635):1511–1512. doi: 10.1136/bmj.296.6635.1511. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mageean R. J. Study of "discharge communications" from hospital. Br Med J (Clin Res Ed) 1986 Nov 15;293(6557):1283–1284. doi: 10.1136/bmj.293.6557.1283. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marsh G. N. Are follow-up consultations at medical outpatient departments futile? Br Med J (Clin Res Ed) 1982 Apr 17;284(6323):1176–1177. doi: 10.1136/bmj.284.6323.1176. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McCormack T. T., Collier J. A., Abel P. D., Collins C. D., Ritchie W. N. Attitudes to follow-up after uncomplicated surgery--hospital out-patients or general practitioner? Health Trends. 1984 May;16(2):46–47. [PubMed] [Google Scholar]
- Metcalfe D. H. Health services in the United Kingdom: trends in provision and utilization 1971-80. Fam Pract. 1984 Sep;1(3):140–146. doi: 10.1093/fampra/1.3.140. [DOI] [PubMed] [Google Scholar]
- Moore A. T., Roland M. O. How much variation in referral rates among general practitioners is due to chance? BMJ. 1989 Feb 25;298(6672):500–502. doi: 10.1136/bmj.298.6672.500. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Petrie J. C., Robb O. J., Webster J., Scott A. K., Jeffers T. A., Park M. D. Computer assisted shared care in hypertension. Br Med J (Clin Res Ed) 1985 Jun 29;290(6486):1960–1962. doi: 10.1136/bmj.290.6486.1960. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rees Gareth J. G. Cost-effectiveness in oncology. Lancet. 1985 Dec 21;2(8469-8470):1405–1408. [PubMed] [Google Scholar]
- Shaw C. D. The problems of out-patient visits. Health Trends. 1981 Nov;13(4):107–108. [PubMed] [Google Scholar]
- Stamp E. J., Jones S. J., Ryrie D. R., Hedley A. J. Oral anticoagulants: a cost-effectiveness approach. J R Coll Physicians Lond. 1985 Apr;19(2):105–108. [PMC free article] [PubMed] [Google Scholar]
- Stewart I. C., McHardy G. J. Audit in a chest clinic. Health Bull (Edinb) 1984 Jan;42(1):45–50. [PubMed] [Google Scholar]
- Stewart I. C., McHardy G. J. Audit in a chest clinic. Health Bull (Edinb) 1984 Jan;42(1):45–50. [PubMed] [Google Scholar]
- West R. R., McKibbin B. Shortening waiting lists in orthopaedic surgery outpatient clinics. Br Med J (Clin Res Ed) 1982 Mar 6;284(6317):728–730. doi: 10.1136/bmj.284.6317.728. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilkin D., Smith A. G. Variation in general practitioners' referral rates to consultants. J R Coll Gen Pract. 1987 Aug;37(301):350–353. [PMC free article] [PubMed] [Google Scholar]
- Wilkin D., Smith A. Explaining variation in general practitioner referrals to hospital. Fam Pract. 1987 Sep;4(3):160–169. doi: 10.1093/fampra/4.3.160. [DOI] [PubMed] [Google Scholar]