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Patient and Clinician Perspectives on Access to NHS Treatments

Investigating patient and clinician perspectives on accessing NHS treatments for carpal tunnel syndrome and adenoid problems

Portfolio Eligibility
Automatically eligible
UKCRN ID 12841
Research Summary
NHS commissioners are encouraged to consider opportunities for NHS savings or ‘disinvestment’, whereby they restrict access to clinical procedures that have ‘low clinical value’ or are not cost-effective in some patients. There are no established methods of identifying which procedures are good candidates for disinvestment. The wider study aims to develop a process that: a) identifies candidate (elective secondary care) procedures for local disinvestment (i.e. within a primary care trust [PCT]), and b) guides disinvestment decision-making. Candidates are identified by examining inter-PCT variation in activity for procedures. Those with high variation, that are carried out particularly frequently within a PCT (‘high use’/’high variation’ procedures), are seen as candidates for local disinvestment. The final decision to restrict access to these procedures (or not) is then informed by existing evidence and local expert views. Qualitative methods have been employed to identify ways of improving the process through investigating how it works in practice. Two NHS commissioning groups are road testing the process. A procedure has been selected for each group [carpal tunnel syndrome surgery and adenoidectomy], based on the above process. The study team have conducted reviews of the evidence supporting best use of each procedure, the results of which will be presented to the commissioning groups. We have ethical approval to observe commissioning group meetings and interview attendees to investigate how they use this evidence (if at all). These efforts will help identify the obstacles to the success of the process, thereby helping us to refine it for future use. We plan to interview clinicians who carry out the procedures in question, and patients who have undergone or may undergo these procedures. These interviews aim to investigate how the disinvestment process could be refined in light of the impact it could have on patients' and clinicians' experiences of care provision.
Study Type Observational
Design Type Qualitative
Disease(s) All Health services and delivery research
Phase N/A
Current Status Closed - in follow-up
Closure Date 3/31/2013
Global Sample Size 25
Global Recruitment to Date
Geographical Scope UK Multi-Centre
Lead Country England
Main Inclusion Criteria
1. Suffolk Inclusion Criteria

a. Eligible clinicians must:
Be responsible for performing surgery on NHS patients with carpal tunnel syndrome at NHS hospital trusts within Suffolk PCT.

b. Eligible patients must:
Have attended an NHS outpatient appointment for a surgical opinion in relation to a working diagnosis of carpal tunnel syndrome, at an NHS hospital trust within Suffolk PCT, within the 12 months preceding recruitment.

2. BNSSG Inclusion Criteria

a. Eligible clinicians must:
Be responsible for performing adenoidectomy on NHS patients at NHS hospital trusts within Bristol, North Somerset or South Gloucestershire PCT.

b. Eligible parents must:
Have attended an NHS outpatient appointment (with their child) during which their child was considered for an adenoidectomy, at an NHS hospital trust within Bristol, North Somerset or South Gloucestershire PCT, within the past 12 months.
Main Exclusion Criteria
Individuals under the age of 18 will be excluded from the study.
Chief Investigator(s)
Prof William Hollingworth
Further details, please contact
Ms Leila Rooshenas

University of Bristol
Department of Social Medicine
Canynge Hall
Whiteladies Road

Tel: 01173313906
Funder(s) NIHR Service Delivery Organisation
Sponsor(s) University Hospitals Bristol NHS Foundation Trust
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