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Tim Peters - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of a general practitioner with special interest service for dermatology: Randomised controlled trial
British Medical Journal, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Andrew Noble, Dilek Berker, Tim PetersAbstract:OBJECTIVE: To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a Hospital dermatology clinic.\n\nDESIGN: Randomised controlled trial.\n\nSETTING: General practitioner with special interest dermatology service and Hospital dermatology clinic.\n\nPARTICIPANTS: Adults referred to a Hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest.\n\nINTERVENTIONS: Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual Hospital Outpatient care.\n\nMAIN OUTCOME MEASURES: Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment.\n\nRESULTS: 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to Hospital Outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service.\n\nCONCLUSIONS: The general practitioner with special interest service for dermatology was more accessible and preferred by patients than Hospital Outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
Chris Salisbury - One of the best experts on this subject based on the ideXlab platform.
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evaluation of a general practitioner with special interest service for dermatology randomised controlled trial
BMJ, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Alison Noble, Dilek Berker, T J PetersAbstract:Abstract Objective To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a Hospital dermatology clinic. Design Randomised controlled trial. Setting General practitioner with special interest dermatology service and Hospital dermatology clinic. Participants Adults referred to a Hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest. Interventions Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual Hospital Outpatient care. Main outcome measures Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients9 perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment. Results 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to Hospital Outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service. Conclusions The general practitioner with special interest service for dermatology was more accessible and preferred by patients than Hospital Outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
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economic evaluation of a general practitioner with special interests led dermatology service in primary care
BMJ, 2005Co-Authors: Joanna Coast, Sue Horrocks, Alison Noble, T J Peters, Sian Noble, O M Asim, Chris SalisburyAbstract:Abstract Objective To carry out an economic evaluation of a general practitioner with special interest service for non-urgent skin problems compared with Hospital Outpatient care. Design Cost effectiveness analysis and cost consequences analysis alongside a randomised controlled trial. Setting General practitioner with special interest dermatology service covering 29 general practices in Bristol. Participants Adults referred to a Hospital dermatology clinic who were potentially suitable for management by a general practitioner with special interest. Interventions Participants were randomised 2:1 to receive either care by general practitioner with special interest service or usual Hospital Outpatient care. Main outcome measures Costs to NHS, patients, and companions, and costs of lost production. Cost effectiveness, using the two primary outcomes of dermatology life quality index scores and improved patient perceived access, was assessed by incremental cost effectiveness ratios and cost effectiveness acceptability curves. Cost consequences are presented in relation to all costs and both primary and secondary outcomes from the trial. Results Costs to the NHS for patients attending the general practitioner with special interest service were £208 ($361; euro 308) compared with £118 for Hospital Outpatient care. Based on analysis with imputation of missing data, costs to patients and companions were £48 and £51, respectively; costs of lost production were £27 and £34, respectively. The incremental cost effectiveness ratios for general practitioner with special interest care over Outpatient care were £540 per one point gain in the dermatology life quality index and £66 per 10 point change in the access scale. Conclusions The general practitioner with special interest service for dermatology is more costly than Hospital Outpatient care, but this additional cost needs to be weighed against improved access and broadly similar health outcomes.
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Evaluation of a general practitioner with special interest service for dermatology: Randomised controlled trial
British Medical Journal, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Andrew Noble, Dilek Berker, Tim PetersAbstract:OBJECTIVE: To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a Hospital dermatology clinic.\n\nDESIGN: Randomised controlled trial.\n\nSETTING: General practitioner with special interest dermatology service and Hospital dermatology clinic.\n\nPARTICIPANTS: Adults referred to a Hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest.\n\nINTERVENTIONS: Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual Hospital Outpatient care.\n\nMAIN OUTCOME MEASURES: Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment.\n\nRESULTS: 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to Hospital Outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service.\n\nCONCLUSIONS: The general practitioner with special interest service for dermatology was more accessible and preferred by patients than Hospital Outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
Max O Bachmann - One of the best experts on this subject based on the ideXlab platform.
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do referral management schemes reduce Hospital Outpatient attendances time series evaluation of primary care referral management
British Journal of General Practice, 2013Co-Authors: Nicholas Steel, Allan Clark, Bharathy Kumaravel, Max O BachmannAbstract:Background Ninety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. Aim To assess the impact of three referral-management centres (RMCs) and two internal peer-review approaches to referral management on Hospital Outpatient attendance rates. Design and setting A retrospective time-series analysis of 376 000 Outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. Method The age-standardised GP-referred first Outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the Outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. Results Referral management was not associated with a reduction in the Outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). Conclusion Referral-management schemes did not reduce Outpatient attendance rates. RMCs were more expensive than internal peer review.
Joanna Coast - One of the best experts on this subject based on the ideXlab platform.
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evaluation of a general practitioner with special interest service for dermatology randomised controlled trial
BMJ, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Alison Noble, Dilek Berker, T J PetersAbstract:Abstract Objective To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a Hospital dermatology clinic. Design Randomised controlled trial. Setting General practitioner with special interest dermatology service and Hospital dermatology clinic. Participants Adults referred to a Hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest. Interventions Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual Hospital Outpatient care. Main outcome measures Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients9 perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment. Results 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to Hospital Outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service. Conclusions The general practitioner with special interest service for dermatology was more accessible and preferred by patients than Hospital Outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
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economic evaluation of a general practitioner with special interests led dermatology service in primary care
BMJ, 2005Co-Authors: Joanna Coast, Sue Horrocks, Alison Noble, T J Peters, Sian Noble, O M Asim, Chris SalisburyAbstract:Abstract Objective To carry out an economic evaluation of a general practitioner with special interest service for non-urgent skin problems compared with Hospital Outpatient care. Design Cost effectiveness analysis and cost consequences analysis alongside a randomised controlled trial. Setting General practitioner with special interest dermatology service covering 29 general practices in Bristol. Participants Adults referred to a Hospital dermatology clinic who were potentially suitable for management by a general practitioner with special interest. Interventions Participants were randomised 2:1 to receive either care by general practitioner with special interest service or usual Hospital Outpatient care. Main outcome measures Costs to NHS, patients, and companions, and costs of lost production. Cost effectiveness, using the two primary outcomes of dermatology life quality index scores and improved patient perceived access, was assessed by incremental cost effectiveness ratios and cost effectiveness acceptability curves. Cost consequences are presented in relation to all costs and both primary and secondary outcomes from the trial. Results Costs to the NHS for patients attending the general practitioner with special interest service were £208 ($361; euro 308) compared with £118 for Hospital Outpatient care. Based on analysis with imputation of missing data, costs to patients and companions were £48 and £51, respectively; costs of lost production were £27 and £34, respectively. The incremental cost effectiveness ratios for general practitioner with special interest care over Outpatient care were £540 per one point gain in the dermatology life quality index and £66 per 10 point change in the access scale. Conclusions The general practitioner with special interest service for dermatology is more costly than Hospital Outpatient care, but this additional cost needs to be weighed against improved access and broadly similar health outcomes.
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Evaluation of a general practitioner with special interest service for dermatology: Randomised controlled trial
British Medical Journal, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Andrew Noble, Dilek Berker, Tim PetersAbstract:OBJECTIVE: To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a Hospital dermatology clinic.\n\nDESIGN: Randomised controlled trial.\n\nSETTING: General practitioner with special interest dermatology service and Hospital dermatology clinic.\n\nPARTICIPANTS: Adults referred to a Hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest.\n\nINTERVENTIONS: Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual Hospital Outpatient care.\n\nMAIN OUTCOME MEASURES: Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment.\n\nRESULTS: 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to Hospital Outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service.\n\nCONCLUSIONS: The general practitioner with special interest service for dermatology was more accessible and preferred by patients than Hospital Outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
Sue Horrocks - One of the best experts on this subject based on the ideXlab platform.
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evaluation of a general practitioner with special interest service for dermatology randomised controlled trial
BMJ, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Alison Noble, Dilek Berker, T J PetersAbstract:Abstract Objective To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a Hospital dermatology clinic. Design Randomised controlled trial. Setting General practitioner with special interest dermatology service and Hospital dermatology clinic. Participants Adults referred to a Hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest. Interventions Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual Hospital Outpatient care. Main outcome measures Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients9 perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment. Results 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to Hospital Outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service. Conclusions The general practitioner with special interest service for dermatology was more accessible and preferred by patients than Hospital Outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
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economic evaluation of a general practitioner with special interests led dermatology service in primary care
BMJ, 2005Co-Authors: Joanna Coast, Sue Horrocks, Alison Noble, T J Peters, Sian Noble, O M Asim, Chris SalisburyAbstract:Abstract Objective To carry out an economic evaluation of a general practitioner with special interest service for non-urgent skin problems compared with Hospital Outpatient care. Design Cost effectiveness analysis and cost consequences analysis alongside a randomised controlled trial. Setting General practitioner with special interest dermatology service covering 29 general practices in Bristol. Participants Adults referred to a Hospital dermatology clinic who were potentially suitable for management by a general practitioner with special interest. Interventions Participants were randomised 2:1 to receive either care by general practitioner with special interest service or usual Hospital Outpatient care. Main outcome measures Costs to NHS, patients, and companions, and costs of lost production. Cost effectiveness, using the two primary outcomes of dermatology life quality index scores and improved patient perceived access, was assessed by incremental cost effectiveness ratios and cost effectiveness acceptability curves. Cost consequences are presented in relation to all costs and both primary and secondary outcomes from the trial. Results Costs to the NHS for patients attending the general practitioner with special interest service were £208 ($361; euro 308) compared with £118 for Hospital Outpatient care. Based on analysis with imputation of missing data, costs to patients and companions were £48 and £51, respectively; costs of lost production were £27 and £34, respectively. The incremental cost effectiveness ratios for general practitioner with special interest care over Outpatient care were £540 per one point gain in the dermatology life quality index and £66 per 10 point change in the access scale. Conclusions The general practitioner with special interest service for dermatology is more costly than Hospital Outpatient care, but this additional cost needs to be weighed against improved access and broadly similar health outcomes.
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Evaluation of a general practitioner with special interest service for dermatology: Randomised controlled trial
British Medical Journal, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Andrew Noble, Dilek Berker, Tim PetersAbstract:OBJECTIVE: To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a Hospital dermatology clinic.\n\nDESIGN: Randomised controlled trial.\n\nSETTING: General practitioner with special interest dermatology service and Hospital dermatology clinic.\n\nPARTICIPANTS: Adults referred to a Hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest.\n\nINTERVENTIONS: Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual Hospital Outpatient care.\n\nMAIN OUTCOME MEASURES: Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment.\n\nRESULTS: 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to Hospital Outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service.\n\nCONCLUSIONS: The general practitioner with special interest service for dermatology was more accessible and preferred by patients than Hospital Outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.