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NB: The information displayed below does not replace the protocol. The latest protocol version should always be consulted before making clinical decisions.
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Patient and Clinician Perspectives on Access to NHS Treatments
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Investigating patient and clinician perspectives on accessing NHS treatments for carpal tunnel syndrome and adenoid problems
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Topic
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Generic Relevance & Cross Cutting Themes
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Portfolio Eligibility
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Automatically eligible
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ISRCTN
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EudraCT
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MREC N°
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UKCRN ID
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12841
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WHO ID
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Research Summary
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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.
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Study Type
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Observational
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Design Type
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Qualitative
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Disease(s)
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Health Services Research
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Phase
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N/A
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Current Status
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Closed - in follow-up
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Closure Date
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3/31/2013
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Global Sample Size
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25
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Global Recruitment to Date
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 | 84% |
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Geographical Scope
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UK Multi-Centre
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Lead Country
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England
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Main Inclusion Criteria
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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.
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Main Exclusion Criteria
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Individuals under the age of 18 will be excluded from the study.
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Chief Investigator(s)
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| Prof William Hollingworth |
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Further details, please contact
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Ms Leila Rooshenas
University of Bristol
Department of Social Medicine
Canynge Hall
Whiteladies Road
Bristol
Somerset
BS8 2PR
UNITED KINGDOM
Tel: 01173313906
leila.rooshenas@bristol.ac.uk
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| Funder(s) |
NIHR Service Delivery Organisation
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| Sponsor(s) |
University Hospitals Bristol NHS Foundation Trust
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