Evaluation of a specialist outreach clinic in a primary healthcare setting: the effect of easy access to specialists

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Background Easy or unrestricted access to specialists improves patient satisfaction and quality of care. However, this may create an overuse of healthcare, induce a demand for costly services and interfere with the ability of the GPs to give comprehensive care.

Objectives We evaluated these controversial aspects of easy accessibility to specialists: health services use, cost (money and time), and the attitude of GPs.

Methods On 1 March 2001, a specialist outreach clinic was established in a homefront military primary care clinic. Patients were referred by primary physicians to nearby specialists, but no further referral was required for continued specialty care. We followed this clinic prospectively for six months. We measured the use of general and specialty services, average monthly costs and loss of workdays by soldiers attending the clinics, and compared values before and after the introduction of the specialist outreach clinic. The same analysis was applied to a similar clinic which employs only GPs and refers soldiers to military specialist centres or to hospital outpatient clinics.

Results The incorporation of specialists did not result in a significant increase in the overall consumption of medical services (P > 0.05). It reduced the number of referrals out of the clinic to regional specialist centres (from 1449 to 421 referrals a month; P < 0.05), to outpatient hospital clinics (from 574 to 419 referrals a month; P < 0.05) and to emergency departments (from 302 to 205 referrals a month; P < 0.05).

In the control clinic, referrals to distant specialist centres and to outpatient clinics showed a slight and non-significant increase.

Loss of workdays was reduced from 2891 working days per month to 1938 days per month (P < 0.001). The total cost of all medical interactions and referrals did not significantly change after the introduction of the outreach specialist clinic (P > 0.05). Primary physicians graded their satisfaction with the newly established clinic as 4.5 (out of 5).

Conclusion Improving access to specialists by patients geographically and by removing the need for a referral for each specialist visit did not increase total healthcare use and cost. It significantly decreased loss of working days and received approval of the clinic's GPs.


Document Type: Miscellaneous

Publication date: August 1, 2002

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