title: The clinical, occupational and financial outcomes associated with a bespoke specialist clinic for military aircrew-a cohort study.
abstract: OBJECTIVE
  To assess the clinical, occupational and financial outcomes of a new Clinical Aviation Medicine Service (CAMS) for UK military personnel.
  
  
  METHODS
  Consecutive patients over a 2 year period were included. Predictors of flying restrictions at referral and final outcome following consultation were modelled using logistic regression. National Health Service (NHS) Payment by Results tariffs and Defence capitation data were used to assess the financial impact of the service.
  
  
  RESULTS
  Eight hundred and sixteen new referrals (94.5% male, median age 45 years (range 19-75)) were received and 1025 consultations performed. Cardiovascular disease was the commonest reason for referral. CAMS clinical activity cost at NHS tariff was £453 310 representing a saving of £316 173 (£137 137 delivery cost). In total, 310/816 (38%) patients had employment restrictions on referral and 49.0% of this group returned to full employment following their initial consultation. Compared with cardiology, general medicine and respiratory patients were more likely to have been occupationally restricted prior to referral (50 vs. 35%, OR 1.81; 95% CI 1.18-2.76, P values=0.006 and 53 vs. 35%, OR 2.12; 95% CI 1.15-3.90, P values = 0.016, respectively). Overall 581/816 (71.2%) of patients returned to unrestricted employment while 98/816 (12.0%) were unable to continue in any aircrew role. The service saved 7000 lost working days per year at an estimated occupational saving of ∼£1 million per annum.
  
  
  CONCLUSIONS
  This bespoke service has allowed rapid, occupationally relevant clinical care to be delivered with both time and financial savings. The model may have significant occupational and financial relevance for other environmental and occupational medical organizations.
authors.affiliation: From the Clinical Aviation Medicine Service, Centre of Aviation Medicine, Royal Air Force Henlow, Bedfordshire SG16 6DN, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Pavitt
authors.affiliation: Department of Medicine, Chelsea and Westminster Hospital NHS Trust, London SW10 9NH, UK.
authors.forename: C W
authors.initials: CW
authors.lastname: Pavitt
authors.affiliation: Department Medical Statistics, London School of Hygiene & Tropical Medicine, UCL, London WC1N 1EH, UK.
authors.forename: K
authors.initials: K
authors.lastname: Harron
authors.affiliation: From the Clinical Aviation Medicine Service, Centre of Aviation Medicine, Royal Air Force Henlow, Bedfordshire SG16 6DN, UK.
authors.forename: M
authors.initials: M
authors.lastname: Jones
authors.affiliation: From the Clinical Aviation Medicine Service, Centre of Aviation Medicine, Royal Air Force Henlow, Bedfordshire SG16 6DN, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Timperley
authors.affiliation: Centre of Aviation Medicine, Royal Air Force Henlow, Bedfordshire SG16 6DN, UK.
authors.forename: A N C
authors.initials: AN
authors.lastname: Reid
authors.affiliation: Centre of Aviation Medicine, Royal Air Force Henlow, Bedfordshire SG16 6DN, UK.
authors.forename: D
authors.initials: D
authors.lastname: Mcloughlin
authors.affiliation: From the Clinical Aviation Medicine Service, Centre of Aviation Medicine, Royal Air Force Henlow, Bedfordshire SG16 6DN, UK.
authors.forename: J
authors.initials: J
authors.lastname: d'Arcy
authors.affiliation: From the Clinical Aviation Medicine Service, Centre of Aviation Medicine, Royal Air Force Henlow, Bedfordshire SG16 6DN, UK Department of Medicine, Chelsea and Westminster Hospital NHS Trust, London SW10 9NH, UK e.nicol@nhs.net.
authors.forename: E D
authors.initials: ED
authors.lastname: Nicol
mesh_terms: D000328:Adult; D000337:Aerospace Medicine / Q000191:economics* / Q000639:trends; D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography / Q000191:economics; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009784:Occupational Diseases / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D017063:Outcome Assessment, Health Care; D000070356:Pilots; D012017:Referral and Consultation / Q000191:economics*; D062707:Return to Work / Q000191:economics; D018570:Risk Assessment; D006113:United Kingdom; D055815:Young Adult