Evaluation of the need for follow-up in an out-patient clinic

Abstract

We have identified 164 patients regularly attending a chest clinic whose condition had been defined as stable on the basis of clear-cut criteria. These patients were randomly allocated to either routine follow-up at 3 monthly intervals (the 'follow-up' group) or annual follow-up (the 'discharge' group). After 1 year, on the basis of a questionnaire sent to the patients' general practitioners, there were no significant differences in outcome between the two groups apart from a just-significant increase in deaths in the 'follow-up' group. Nevertheless, at the conclusion of the trial clinic doctors felt that only 45% of patients and general practitioners that only 27% of patients should be discharged from the clinic. At the conclusion of the study patients in the 'discharge' group were significantly more likely to feel that they had been attending too infrequently and that their condition had worsened, although the latter was not borne out by objective data. We suggest that all these patients could have been discharged from the clinic without any difference in outcome. This study highlights the reluctance of clinic doctors and general practitioners to consider and effect the discharge of stable patients from routine clinic attendance.