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Re-consultation, self-reported health status, and costs following treatment at a Musculoskeletal Clinical Assessment and Treatment Service (CATS): a twelve-month prospective cohort study

Roddy, Edward; Jordan, Kelvin P; Oppong, Raymond; Chen, Ying; Jowett, Sue; Dawes, Peter; Hider, Samantha L; Packham, Jon; Stevenson, Kay; Zwierska, Irena; Hay, Elaine M

Re-consultation, self-reported health status, and costs following treatment at a Musculoskeletal Clinical Assessment and Treatment Service (CATS): a twelve-month prospective cohort study Thumbnail


Authors

Raymond Oppong

Ying Chen

Sue Jowett

Peter Dawes

Jon Packham

Kay Stevenson

Irena Zwierska



Abstract

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.

Citation

Roddy, E., Jordan, K. P., Oppong, R., Chen, Y., Jowett, S., Dawes, P., …Hay, E. M. (2016). Re-consultation, self-reported health status, and costs following treatment at a Musculoskeletal Clinical Assessment and Treatment Service (CATS): a twelve-month prospective cohort study. BMJ Open, 6(10), https://doi.org/10.1136/bmjopen-2016-011735

Journal Article Type Article
Acceptance Date Sep 21, 2016
Online Publication Date Oct 12, 2016
Publication Date Oct 12, 2016
Journal BMJ Open
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 6
Issue 10
DOI https://doi.org/10.1136/bmjopen-2016-011735
Keywords musculoskeletal, clinical assessment, cohort study
Publisher URL http://dx.doi.org/10.1136/bmjopen-2016-011735