Study of the taking of a patients’ history by telephone prior to clinic attendance and co-ordinating investigations for new respiratory patients showed a reduction in hospital attendances with no detrimental impact on patients (ERS 2010). Health service costs were not originally addressed but are now considered.
Methods One hundred consecutive patients were invited to have a pre-clinic telephone consultation; 49% (49/100) accepted; 51% (51/100) declined/failed to respond. Fifty-seven patients referred through the electronic Choose and Book (C&B) system during the same period formed a comparator group. The costs of delivery included the pre-clinic telephone consultations in the intervention group and first and follow-up clinic consultation in both groups. Two perspectives were taken, the purchaser (NHS Primary Care Trust) who incurs the cost of delivery, and the hospital who bear the financial burden for non-attendance.
Results In the intervention group, 98% (48/49) had a pre-clinic telephone consultation, 100% had an initial clinic consultation and 36.7% (18/49) had one or more follow-up appointments. In the C&B arm, 82% (47/57) of patients attended the first consultation and 49% (28/57) had one or more follow-ups. Taking the perspective of the purchaser there were 48 telephone patients, and 47 C&B patients. There was no cost for non-attendance from this perspective. The costs per patient for the telephone group were £340, and for the C&B group £359. This was not a significant difference (mean difference of £-20 (95% CI −74.60, 34.70, p=0.470)). From the hospital perspective there were 49 patients in the telephone group and 53 in the C&B group. The cost of non-attendance and rearranged appointments for 6 months from first planned contact was £19 per patient (telephone group) and £71 (C&B), mean difference £−52 (95% CI −97.24, −6.11, p=0.027).
Conclusion Pre-clinic telephone consultations have been shown to be cost-saving for hospitals, substantially reducing the financial burden of non-attendance. From the PCT perspective there was no statistical difference in the cost of delivery between the two groups. This study used observational data from a self-selected patient group, further work is needed to confirm findings.
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Funding This work was supported by the Dunhill Medical Trust.
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