Editor—Rosen et al say that the evidence for the effectiveness of general practitioner specialist clinics is almost non-existent.1 This ignores the literature on primary care led chronic disease management clinics in areas such as diabetes, asthma, and hypertension. More recently there has been a growing body of evidence to support the role of primary care clinics in the management of oral anticoagulation.
The evidence both in terms of clinical outcomes and patients' preference points to primary care clinics being the preferred model of service delivery.2 This has been recognised within the recent general practitioners' contract with, for the first time, recognition of this service as a form of chronic disease management.
I agree that minimum standards of competence need to be specified—something I have campaigned for in anticoagulation for several years—but it would be unfortunate if this potentially effective form of intervention was left stillborn due to stagnating bureaucracy when there are extant models of care that are clinically effective and cost effective and also preferred by patients.
Competing interests: None declared.
References
- 1.Rosen R, Stevens R, Jones R. General practitioners with special clinical interests. BMJ 2003;327: 460-2. (30 August.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Fitzmaurice DA, Hobbs FDR, Murray ET, Holder RL, Allan TF, Rose PE. Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing. Randomized, controlled trial. Arch Intern Med 2000;160: 2343-8. [DOI] [PubMed] [Google Scholar]