Article

Reforming respiratory outpatient services: a before-and-after observational study assessing the impact of a quality improvement project applying British Thoracic Society criteria to the discharge of patients to primary care

  • Primary Care Respiratory Journal (2013) 22, 7278
  • doi:10.4104/pcrj.2013.00013
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Abstract

Background:

Secondary care physicians caring for people with long-term conditions (LTCs) are under increasing pressure to discharge long-term follow-up patients to primary care. In respiratory medicine, the 2008 British Thoracic Society (BTS) statement on criteria for specialist referral, admission, discharge, and follow-up for adults with respiratory disease remains the only available basis for this dialogue. There is widespread concern about reforming outpatient clinics to meet these demands and the impact of discharging people with respiratory LTCs to primary care.

Aims:

To examine the impact of implementing BTS guidance on secondary care follow-up of patients with respiratory disease.

Methods:

We undertook a clinic reform project, which included one-stop medical reviews, providing more open access appointments, and implementing the BTS criteria. The impact on patients was assessed by patient survey, and the impact on GPs was assessed by an analysis of referral patterns pre- and post-reform.

Results:

There was a significant improvement in commissioner-mandated performance through reduction in follow-up (p=0.006) and the unscheduled hospital admission rate decreased significantly (p=0.021). However, many patients were dissatisfied with the process and re-referral rates rose.

Conclusions:

Our findings suggest that the delivery of a responsive service capable of sustainable management of respiratory LTCs can be achieved using the BTS criteria. It seems to be efficacious within secondary care, increasing the quality and value of the clinic activity, although hidden impacts on primary care will require further prospective studies.

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Acknowledgements

Handling editor Niels Chavannes

Statistical review Gopal Netuveli

We would like to extend thanks to all the patients who contributed opinions to our patient satisfaction survey.

Funding This study received no specific funding. AMT has current funding from the Wellcome Trust, NIHR HTA, Alpha 1 Foundation, UHB charities and Linde REALfund; none of her funders had any input to this study.

Author information

Affiliations

  1. University of Birmingham, QEHB Research Laboratories, QEHB, Birmingham, UK

    • Alice M Turner
  2. Department of Respiratory Medicine, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK

    • Alice M Turner
    • , Satinder Kaur Dalay
    • , Ambika Talwar
    • , Catherine Snelson
    •  & Rahul Mukherjee

Authors

  1. Search for Alice M Turner in:

  2. Search for Satinder Kaur Dalay in:

  3. Search for Ambika Talwar in:

  4. Search for Catherine Snelson in:

  5. Search for Rahul Mukherjee in:

Contributions

AMT conducted all data analyses, some data collection, some of the patient satisfaction survey and drafted the manuscript. SD and CS collected data. AT contributed to the patient satisfaction survey. RM conceived the study and supervised the work.

Competing interests

The authors declare that they have no conflicts of interest in relation to this article.

Corresponding author

Correspondence to Alice M Turner.

Appendices

Appendix 1. Clinic reform manuscript SQUIRE checklist