TY - JOUR
T1 - Reconsultation, self-reported health status and costs following treatment at a musculoskeletal Clinical Assessment and Treatment Service (CATS)
T2 - A 12-month prospective cohort study
AU - Roddy, Edward
AU - Jordan, Kelvin P.
AU - Oppong, Raymond
AU - Chen, Ying
AU - Jowett, Sue
AU - Dawes, Peter
AU - Hider, Samantha L.
AU - Packham, Jon
AU - Stevenson, Kay
AU - Zwierska, Irena
AU - Hay, Elaine M.
N1 - Funding Information:
This work is supported by an Arthritis Research UK Integrated Clinical Arthritis Centre Grant (17684), the Arthritis Research UK Primary Care Centre Grant (18139), funding secured from Stoke-on-Trent Primary Care Trust (PCT) and service support through the West Midlands North CLRN. KS is part-funded by a NIHR Knowledge Mobilisation Fellowship (KMF-2012-01-35).
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Objectives: To determine (1) reconsultation frequency, (2) change in self-reported health status, (3) baseline factors associated with reconsultation and change in health status and (4) associated healthcare costs and quality-adjusted life-years (QALYs), following assessment at a musculoskeletal Clinical and Assessment Treatment Service (CATS). Design: Prospective cohort study. Setting: Single musculoskeletal CATS at the primary-secondary care interface. Participants: 2166 CATS attenders followed-up by postal questionnaires at 6 and 12 months and review of medical records. Outcome measures: Primary outcome was consultation in primary care with the same musculoskeletal problem within 12 months. Secondary outcome measures were consultation at the CATS with the same musculoskeletal problem within 12 months, physical function and pain (Short Form-36), anxiety and depression (Hospital Anxiety and Depression Scale), time off work, healthcare costs and QALYs. Results: Over 12 months, 507 (38%) reconsulted for the same problem in primary care and 345 (26%) at the CATS. Primary care reconsultation in the first 3 months was associated with baseline pain interference (relative risk ratio 5.33; 95% CI 3.23 to 8.80) and spinal pain (1.75; 1.09 to 2.82), and after 3-6 months with baseline assessment by a hospital specialist (2.06; 1.13 to 3.75). Small mean improvements were seen in physical function (1.88; 95% CI 1.44 to 2.32) and body pain (3.86; 3.38 to 4.34) at 6 months. Poor physical function at 6 months was associated with obesity, chronic pain and poor baseline physical function. Mean (SD) 6-month cost and QALYs per patient were £422.40 (660.11) and 0.257 (0.144), respectively. Conclusions: While most patients are appropriate for a 'one-stop shop' model, those with troublesome, disabling pain and spinal pain commonly reconsult and have ongoing problems. Services should be configured to identify and address such clinical complexity.
AB - Objectives: To determine (1) reconsultation frequency, (2) change in self-reported health status, (3) baseline factors associated with reconsultation and change in health status and (4) associated healthcare costs and quality-adjusted life-years (QALYs), following assessment at a musculoskeletal Clinical and Assessment Treatment Service (CATS). Design: Prospective cohort study. Setting: Single musculoskeletal CATS at the primary-secondary care interface. Participants: 2166 CATS attenders followed-up by postal questionnaires at 6 and 12 months and review of medical records. Outcome measures: Primary outcome was consultation in primary care with the same musculoskeletal problem within 12 months. Secondary outcome measures were consultation at the CATS with the same musculoskeletal problem within 12 months, physical function and pain (Short Form-36), anxiety and depression (Hospital Anxiety and Depression Scale), time off work, healthcare costs and QALYs. Results: Over 12 months, 507 (38%) reconsulted for the same problem in primary care and 345 (26%) at the CATS. Primary care reconsultation in the first 3 months was associated with baseline pain interference (relative risk ratio 5.33; 95% CI 3.23 to 8.80) and spinal pain (1.75; 1.09 to 2.82), and after 3-6 months with baseline assessment by a hospital specialist (2.06; 1.13 to 3.75). Small mean improvements were seen in physical function (1.88; 95% CI 1.44 to 2.32) and body pain (3.86; 3.38 to 4.34) at 6 months. Poor physical function at 6 months was associated with obesity, chronic pain and poor baseline physical function. Mean (SD) 6-month cost and QALYs per patient were £422.40 (660.11) and 0.257 (0.144), respectively. Conclusions: While most patients are appropriate for a 'one-stop shop' model, those with troublesome, disabling pain and spinal pain commonly reconsult and have ongoing problems. Services should be configured to identify and address such clinical complexity.
UR - http://www.scopus.com/inward/record.url?scp=84991711000&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2016-011735
DO - 10.1136/bmjopen-2016-011735
M3 - Article
C2 - 27733409
AN - SCOPUS:84991711000
SN - 2044-6055
VL - 6
JO - BMJ Open
JF - BMJ Open
IS - 10
M1 - e011735
ER -