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An integrated care pathway for menorrhagia across the primary–secondary interface : patients' experience, clinical outcomes, and service utilisation

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Julian, Sophia , Naftalin, Nicholas J., Clark, M. D. (Michael D.), Szczepura, Ala, Rashid, Aly , Baker, Richard, Taub, Nicholas and Habiba, Marwan . (2007) An integrated care pathway for menorrhagia across the primary–secondary interface : patients' experience, clinical outcomes, and service utilisation. Quality and Safety in Health Care, Vol.16 . pp. 110-115. ISSN 1475-3898

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Official URL: http://dx.doi.org/10.1136/qshc.2005.016782

Abstract

Background: ‘‘Referral’’ characterises a significant area of interaction between primary and secondary care.
Despite advantages, it can be inflexible, and may lead to duplication.
Objective: To examine the outcomes of an integrated model that lends weight to general practitioner (GP)-led
evidence based care.
Design: A prospective, non-random comparison of two services: women attending the new (Bridges) pathway
compared with those attending a consultant-led one-stop menstrual clinic (OSMC). Patients’ views were
examined using patient career diaries, health and clinical outcomes, and resource utilisation. Follow-up was
for 8 months.
Setting: A large teaching hospital and general practices within one primary care trust (PCT).
Results: Between March 2002 and June 2004, 99 women in the Bridges pathway were compared with 94
women referred to the OSMC by GPs from non-participating PCTs. The patient career diary demonstrated a
significant improvement in the Bridges group for patient information, fitting in at the point of arrangements
made for the patient to attend hospital (ease of access) (p,0.001), choice of doctor (p = 0.020), waiting time
for an appointment (p,0.001), and less ‘‘limbo’’ (patient experience of non-coordination between primary
and secondary care) (p,0.001). At 8 months there were no significant differences between the two groups in
surgical and medical treatment rates or in the use of GP clinic appointments. Significantly fewer (traditional)
hospital outpatient appointments were made in the Bridges group than in the OSMC group (p,0.001).
Conclusion: A general practice-led model of integrated care can significantly reduce outpatient attendance
while improving patient experience, and maintaining the quality of care.

Item Type:

Journal Article

Subjects:

R Medicine > R Medicine (General)
R Medicine > RG Gynecology and obstetrics

Divisions:

Faculty of Medicine > Warwick Medical School

Library of Congress Subject Headings (LCSH):

Integrated delivery of health care, Menorrhagia

Journal or Publication Title:

Quality and Safety in Health Care

Publisher:

BMJ

ISSN:

1475-3898

Official Date:

2007

Dates:

Date	Event
2007	Published

Volume:

Vol.16

Page Range:

pp. 110-115

Identification Number:

10.1136/qshc.2005.016782

Status:

Peer Reviewed

Access rights to Published version:

Open Access

Description:

Final version (as published).

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