This practice near Bristol dramatically reduced the number of patients frequently attending the surgery with symptoms not easily related to an identifiable medical condition.
The Frome Valley Medical Centre, in Frampton, identified 150 patients who had attended surgery more than six times in six months - often resulting in a spiral of appointments, investigations and referrals.
The practice used the BATHE technique to help these patients develop the skills and confidence to manage their own health, calling on the appropriate clinician for aid at the appropriate time.
BATHE represents a series of questions for the patient (Background, Affect, Trouble, Handling, Empathy) aiming to identify the problem and why they are struggling to deal with it, and offer ways to improve their confidence in addressing the issue.
Each frequent attender was allocated to the GP who knew them best, and became, with the patient's agreement, their 'usual'
doctor. The GP developed a bespoke care plan for each allocated patient and over time, titrated attendances to more normal levels.
Individual medical records were flagged to indicate that the patient was participating in the programme and to identify their GP.
When a patient requested an appointment, they were telephoned by the GP to establish whether a face-to-face consultation would really be necessary.
The consultation, whether conducted on the telephone or face-to-face, used the BATHE technique.
Patients were also offered participation in a patient support group, including a quarterly meeting with the programme psychologist and a quarterly newsletter.
After nine months, the programme had saved £18,986 in GP appointments, two unplanned admissions and £8,165 on 35 referrals to secondary care. In a user satisfaction survey, 71% of the patients rated the programme as 'very good', 25% as 'good' and 4% as 'fair'.
The practice initiated a second group of frequent attenders using the same search criteria, and only four patients from the first cohort remained as frequent attenders in the second.
- For more about the technique, search 'BATHE' at GPonline.com
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