title: Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational impact study.
abstract: OBJECTIVE
  In line with a national policy to move care 'closer to home', a specialist children's hospital in the National Health Service in England introduced consultant-led 'satellite' clinics to two community settings for general paediatric outpatient services. Objectives were to reduce non-attendance at appointments by providing care in more accessible locations and to create new physical clinic capacity. This study evaluated these satellite clinics to inform further development and identify lessons for stakeholders.
  
  
  METHODS
  Impact of the satellite clinics was assessed by comparing community versus hospital-based clinics across the following measures: (1) non-attendance rates and associated factors (including patient characteristics and travel distance) using a logistic regression model; (2) percentage of appointments booked within local catchment area; (3) contribution to total clinic capacity; (4) time allocated to clinics and appointments; and (5) clinic efficiency, defined as the ratio of income to staff-related costs.
  
  
  RESULTS
  Satellite clinics did not increase attendance beyond their contribution to shorter travel distance, which was associated with higher attendance. Children living in the most-deprived areas were 1.8 times more likely to miss appointments compared with those from least-deprived areas. The satellite clinics' contribution to activity in catchment areas and to total capacity was small. However, one of the two satellite clinics was efficient compared with most hospital-based clinics.
  
  
  CONCLUSIONS
  Outpatient clinics were relocated in pragmatically chosen community settings using a 'drag and drop' service model. Such clinics have potential to improve access to specialist paediatric healthcare, but do not provide a panacea. Work is required to improve attendance as part of wider efforts to support vulnerable families. Satellite clinics highlight how improved management could contribute to better use of existing capacity.
authors: Health Economics Unit, University of Birmingham, Birmingham, UK.
authors: Hugh
authors: H
authors: McLeod
authors: School of Life and Health Sciences, Aston University, Birmingham, UK.
authors: Gemma
authors: G
authors: Heath
authors: Manchester Centre for Health Psychology, University of Manchester, Manchester, UK.
authors: Elaine
authors: E
authors: Cameron
authors: Department of General Paediatrics, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
authors: Geoff
authors: G
authors: Debelle
authors: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK.
authors: Carole
authors: C
authors: Cummins
mesh_terms: D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration; D003253:Consultants / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010372:Pediatrics / Q000458:organization & administration; D058996:Quality Improvement; D006113:United Kingdom
keywords: Health policy; Health services research; Healthcare quality improvement; Paediatrics; Patient-centred care