The burden to primary care caused by ‘waiting’ for a tonsillectomy
Rapid response to:
Primary Care
Antibiotic prescribing in general practice and hospital admissions for peritonsillar abscess, mastoiditis, and rheumatic fever in children: time trend analysis
The burden to primary care caused by ‘waiting’ for a tonsillectomy
Recurrent acute infective conditions such as tonsillitis highlight a
difficult area in which to reduce general practice prescribing of
antibiotics. Tonsillitis, if correctly indicated, can be treated with a
tonsillectomy and alleviate the need for antibiotics.
However, lengthy operative waiting times mean patients continue to seek
antibiotic prescriptions from their general practitioner until their
operation.
We designed this study to look at the effect on primary care of a six
month wait between listing and operating for tonsillectomy. In
particular, we looked at the number of visits made to the local General
Practitioner (GP), prescriptions made and referrals to hospital.
All children waiting longer than six months for tonsillectomy on the
hospital admissions waiting list were recruited. A simple questionnaire
was sent to the GP’s for information on patient visits during the defined
six month period. We recorded the number of visits made by the child for
problems pertaining to tonsillitis, the number of antibiotics and
analgesics provided and the number of consultations requiring referral to
hospital.
We sent out 183 questionnaires and received 94 (51% response rate).
Eleven of the returned questionnaires had no responses, therefore, we
analysed data on 83 patients. The median age of the group was seven years
(range 3 to 16). Twenty four patients did not seek a consultation with
their GP during six months of waiting for their tonsillectomy. The
remaining patients made between one and six visits to their GP with a
total of 152 visits in the six month duration. Nearly half the children,
in this study, visited their GP three or more times for problems
pertaining to tonsillitis. There was an even mix of antibiotic and
analgesics prescribed with a total of one hundred and thirty-seven
scripts. Nineteen patients were referred back to hospital. This was
either to casualty or to the otolaryngologist for further consultation.
Overall, there was a 55% chance of a child visiting their GP during any
six month period between time of listing and tonsillectomy.
Whilst the financial constraints within the National Health Service
are well recognised, it is important to appreciate the costs to the
primary care sector, of patients ‘waiting’ for an operation. Various
implications of long waiting times for operations have been looked at
before but the impact of a recurrent acute condition, such as tonsillitis,
in the primary care sector has not been defined.1 According to our study,
seventy per cent of children waiting six months for a tonsillectomy will
visit their GP at least once. This equates to nearly two visits per
child. This is a surprisingly high burden at primary care level with cost
implications in terms of prescription made and consultation time.
Although we chose to study a six month period, many hospitals have
variable waiting times, with some exceeding six months2. It is not
unreasonable to conclude that the longer the time to operation the higher
the burden to local GP’s. Interestingly, twenty per cent of children
required a hospital referral for further treatment or review. This might
be as a consequence of the multiple GP attendances made by some patients
or because the severity of symptoms had changed.
Tonsillitis has frequent recurrent acute episodes, which may require
repeat medical consultation and treatment. Lengthy waiting times for
tonsillectomy could have cost implication at the primary care level. By
defining this burden, we provide further support for the need to reduce
waiting times. Other conditions characterised by recurrent acute
presentations in otolaryngology and other specialties may have similar
implications in terms of cost at primary care level.
References
1. Yue Casena FH, Favarato D, Machado Cesar LA, de Oliveira SA, da Luz
PL. Cardiac complications during waiting for elective coronary artery
bypass grafo surgery: incidence, temporal distribution and predictive
factors. Eur J Cardiothorac Surg. 2004 Feb; 25(2):196-202.
2. Prim MP, de Diego JI, Larrauri M, Diaz C, Sastre N, Gavilan J.
Spontaneous resolution of recurrent tonsillitis in pediatric patients on
the surgical waiting list. J Pediatr Otorhinolaryngol. 2202 Aug
1;65(1):35-8.
Rapid Response:
The burden to primary care caused by ‘waiting’ for a tonsillectomy
Recurrent acute infective conditions such as tonsillitis highlight a
difficult area in which to reduce general practice prescribing of
antibiotics. Tonsillitis, if correctly indicated, can be treated with a
tonsillectomy and alleviate the need for antibiotics.
However, lengthy operative waiting times mean patients continue to seek
antibiotic prescriptions from their general practitioner until their
operation.
We designed this study to look at the effect on primary care of a six
month wait between listing and operating for tonsillectomy. In
particular, we looked at the number of visits made to the local General
Practitioner (GP), prescriptions made and referrals to hospital.
All children waiting longer than six months for tonsillectomy on the
hospital admissions waiting list were recruited. A simple questionnaire
was sent to the GP’s for information on patient visits during the defined
six month period. We recorded the number of visits made by the child for
problems pertaining to tonsillitis, the number of antibiotics and
analgesics provided and the number of consultations requiring referral to
hospital.
We sent out 183 questionnaires and received 94 (51% response rate).
Eleven of the returned questionnaires had no responses, therefore, we
analysed data on 83 patients. The median age of the group was seven years
(range 3 to 16). Twenty four patients did not seek a consultation with
their GP during six months of waiting for their tonsillectomy. The
remaining patients made between one and six visits to their GP with a
total of 152 visits in the six month duration. Nearly half the children,
in this study, visited their GP three or more times for problems
pertaining to tonsillitis. There was an even mix of antibiotic and
analgesics prescribed with a total of one hundred and thirty-seven
scripts. Nineteen patients were referred back to hospital. This was
either to casualty or to the otolaryngologist for further consultation.
Overall, there was a 55% chance of a child visiting their GP during any
six month period between time of listing and tonsillectomy.
Whilst the financial constraints within the National Health Service
are well recognised, it is important to appreciate the costs to the
primary care sector, of patients ‘waiting’ for an operation. Various
implications of long waiting times for operations have been looked at
before but the impact of a recurrent acute condition, such as tonsillitis,
in the primary care sector has not been defined.1 According to our study,
seventy per cent of children waiting six months for a tonsillectomy will
visit their GP at least once. This equates to nearly two visits per
child. This is a surprisingly high burden at primary care level with cost
implications in terms of prescription made and consultation time.
Although we chose to study a six month period, many hospitals have
variable waiting times, with some exceeding six months2. It is not
unreasonable to conclude that the longer the time to operation the higher
the burden to local GP’s. Interestingly, twenty per cent of children
required a hospital referral for further treatment or review. This might
be as a consequence of the multiple GP attendances made by some patients
or because the severity of symptoms had changed.
Tonsillitis has frequent recurrent acute episodes, which may require
repeat medical consultation and treatment. Lengthy waiting times for
tonsillectomy could have cost implication at the primary care level. By
defining this burden, we provide further support for the need to reduce
waiting times. Other conditions characterised by recurrent acute
presentations in otolaryngology and other specialties may have similar
implications in terms of cost at primary care level.
References
1. Yue Casena FH, Favarato D, Machado Cesar LA, de Oliveira SA, da Luz
PL. Cardiac complications during waiting for elective coronary artery
bypass grafo surgery: incidence, temporal distribution and predictive
factors. Eur J Cardiothorac Surg. 2004 Feb; 25(2):196-202.
2. Prim MP, de Diego JI, Larrauri M, Diaz C, Sastre N, Gavilan J.
Spontaneous resolution of recurrent tonsillitis in pediatric patients on
the surgical waiting list. J Pediatr Otorhinolaryngol. 2202 Aug
1;65(1):35-8.
Competing interests:
None declared
Competing interests: No competing interests