Costs and benefits of a one stop clinic compared with a dedicated breast clinic: randomised controlled trialCommentary: one stop clinics should not be abandoned
Editor- One-Stop (Fast Track, Rapid Diagnostic) breast
clinics were introduced over 10 years ago. The aim is to
decrease patient distress while waiting for
investigations and results. The paper by Dey et al
shows clearly there is a significant improvement of
anxiety levels in one-stop clinics at 24 hours
p<0.00011. It is not surprising that at 3 weeks and 3
months there was no significant difference between the
clinics and it is not clear why the authors chose these
time intervals.
A recent study performed in our unit of 464 new
patients attending a one-stop clinic, showed that the
overall patient satisfaction of the one-stop clinic was
8.91 on a scale of 0-10 and the patients with a
diagnosis of cancer had the highest satisfaction of
9.12. Rather than receive the results at a later date,
84% of patients stated they were happy to wait for
results in the one-stop clinic 2.
Dey et al found one-stop clinics more costly, this can be
explained firstly by the differences in the number of
ultrasound scans performed; 88.4%in the one stop
clinic compared to 17.5% in the dedicated breast clinic.
Secondly the small number of new patients seen in the
one-stop clinic (10 new patients per clinic) is an
uneconomic use of the radiologists and pathologists
time.
One stop clinics are useful especially in large busy
units and with the correct organisation can be cost
effective. In our unit where the demand for outpatient
appointments is high and increasing, seeing patients
in the one-stop clinic has helped to keep the waiting
times down, indeed our personal experience shows
that only 25% of new patients require more than one
visit to the clinic. We do accept that with the increasing
use of core biopsy some patients will need to attend
the clinic on more than one occasion. However, for the
majority of patients who are suitable for Fine Needle
Aspiration Cytology, the one-stop clinic remains an
attractive option.
Amanda Thorne Dunhill Research Fellow thornea@doctors.org.uk
Constantinos Yiangou Consultant Surgeon
Department of Breast Surgery, Queen Alexandra
Hospital, Portsmouth, PO6 3LY.
1. Dey P, Bundred N, Gibbs A, Hopwood P, Baildam A,
Boggis C, James M, Knox F, Leidecker V, Woodman C.
Cost and benefits of a one stop clinic compared with a
dedicated breast clinic: randomised controlled trial.
BMJ 2002; 324:507 (2 March).
2. Thorne AL, Yiangou C. Fast track breast clinics: do
they have a future? European Journal of Surgical
Oncology 2001, 27 (8): 782.
Competing interests:
No competing interests
29 March 2002
Amanda L Thorne
Research Fellow
Constantinos Yiangou
Queen Alexandra Hospital Portsmouth Hampshire PO6 3LY U.K
Rapid Response:
Patients like one-stop breast clinics
Patients like one-stop breast clinics.
Editor- One-Stop (Fast Track, Rapid Diagnostic) breast
clinics were introduced over 10 years ago. The aim is to
decrease patient distress while waiting for
investigations and results. The paper by Dey et al
shows clearly there is a significant improvement of
anxiety levels in one-stop clinics at 24 hours
p<0.00011. It is not surprising that at 3 weeks and 3
months there was no significant difference between the
clinics and it is not clear why the authors chose these
time intervals.
A recent study performed in our unit of 464 new
patients attending a one-stop clinic, showed that the
overall patient satisfaction of the one-stop clinic was
8.91 on a scale of 0-10 and the patients with a
diagnosis of cancer had the highest satisfaction of
9.12. Rather than receive the results at a later date,
84% of patients stated they were happy to wait for
results in the one-stop clinic 2.
Dey et al found one-stop clinics more costly, this can be
explained firstly by the differences in the number of
ultrasound scans performed; 88.4%in the one stop
clinic compared to 17.5% in the dedicated breast clinic.
Secondly the small number of new patients seen in the
one-stop clinic (10 new patients per clinic) is an
uneconomic use of the radiologists and pathologists
time.
One stop clinics are useful especially in large busy
units and with the correct organisation can be cost
effective. In our unit where the demand for outpatient
appointments is high and increasing, seeing patients
in the one-stop clinic has helped to keep the waiting
times down, indeed our personal experience shows
that only 25% of new patients require more than one
visit to the clinic. We do accept that with the increasing
use of core biopsy some patients will need to attend
the clinic on more than one occasion. However, for the
majority of patients who are suitable for Fine Needle
Aspiration Cytology, the one-stop clinic remains an
attractive option.
Amanda Thorne Dunhill Research Fellow
thornea@doctors.org.uk
Constantinos Yiangou Consultant Surgeon
Department of Breast Surgery, Queen Alexandra
Hospital, Portsmouth, PO6 3LY.
1. Dey P, Bundred N, Gibbs A, Hopwood P, Baildam A,
Boggis C, James M, Knox F, Leidecker V, Woodman C.
Cost and benefits of a one stop clinic compared with a
dedicated breast clinic: randomised controlled trial.
BMJ 2002; 324:507 (2 March).
2. Thorne AL, Yiangou C. Fast track breast clinics: do
they have a future? European Journal of Surgical
Oncology 2001, 27 (8): 782.
Competing interests: No competing interests