Delivering an effective outpatient service in Gynaecology. An assessment of patients’ preference
Objectives To assess whether patients would prefer to undergo outpatient or day-case hysteroscopy for the investigation of abnormal uterine bleeding.
Design An anonymous questionnaire.
Setting A general gynaecology clinic in a large UK teaching hospital.
Subjects 250 consecutive patients attending the gynaecology clinic.
Main outcome measures These were patient preference for either outpatient or day-case hysteroscopy, and the reasons for the decisions.
Results The questionnaire was completed by189 patients (76% response rate). Of these 52% chose outpatient hysteroscopy, 26% chose day-case hysteroscopy, 17% wanted to let the doctor decide and 5% needed more information. We found that women in employment and those who had previously undergone review were significantly more likely to opt for outpatient hysteroscopy. The most common reason for preferring outpatient hysteroscopy was that the entire process was quick, whereas the main reason for NOT favouring it was the potential for discomfort. The main appeal of day-case hysteroscopy for patients was that no pain would be felt during the procedure; the most common reason for disliking day-case hysteroscopy was the possible wait for up to 3 hours in the day-case unit before hysteroscopy was performed.
Conclusions When given the choice, women prefer to undergo outpatient rather than daycase hysteroscopy for the investigation of abnormal uterine bleeding. From the patient's perspective, the most common reasons for preferring outpatient hysteroscopy are (in order of priority): the speed of the entire process; the uninterrupted sequence of counselling, investigation and information regarding results, and the shorter wait in hospital before the hysteroscopy is performed.
Available from: Catharina E Jacobi
- "A great advantage of hysteroscopy over SIS is the possibility to perform a directed biopsy or a small surgical intervention in the same session. Moreover, gynaecological treatments in an outpatient setting have shown to be highly acceptable and popular with patients [7, 8]. "
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ABSTRACT: This study was conducted to assess whether women would prefer to undergo saline infusion sonography (SIS) or office hysteroscopy for the investigation of the uterine cavity. In a randomised controlled trial, 100 patients underwent SIS or office hysteroscopy for assessing patients' pain scores. After the investigation, 92 of them were asked to fill out an anonymous questionnaire addressing their preference regarding the method of evaluation and treatment of the uterine cavity. A control group, consisting of 50 women who never underwent SIS or office hysteroscopy, was also asked to complete an identical questionnaire. The questionnaire was completed by 113 women (83.7%). Twenty-four (21.2%) women would opt for SIS, whereas 52 (46.0%) would opt for office hysteroscopy, and 37 (32.7%) had no preference. If therapy would be necessary, 48.7% of the women would opt for an outpatient treatment, whereas 33.0% of the women would prefer treatment under general anaesthesia. Despite the fact that SIS is less painful, the majority of the women prefer office hysteroscopy. Additionally, therapy in an outpatient setting is preferred to a day case setting.
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ABSTRACT: To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer.
Randomised controlled trial.
The gynaecology clinic of a large teaching hospital.
Ninety-seven women with abnormal uterine bleeding requiring investigation.
Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy.
Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses.
The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P < 0.001. Of those women who lost income due to the hysteroscopy, the average loss of income was twice as much in the daycase group ( pound 20.40 in the outpatient group vs pound 50.60 in the daycase group). The average cost of childcare required to cover the time spent in hospital undergoing the hysteroscopy was similar in both groups, however, the number of women requiring childcare was small. Travel costs incurred by the women were 74% more in the daycase group compared with the outpatient group-with an average cost of pound 3.46 in the outpatient group and pound 6.02 in the daycase group. Daycase hysteroscopy costs the National Health Service approximately pound 53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service.
Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.
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ABSTRACT: Flexible hysteroscopy is a safe, successful, and reliable method of investigation for abnormal uterine bleeding. When compared with rigid hysteroscopy flexible hysteroscopy is associated with less pain both at introduction of the hysteroscope and during the procedure itself especially when the diameter of the scope is reduced. This article provides evidence of the benefits of flexible hysteroscopy to the health service provider, clinician, and patient. Flexible hysteroscopy is acceptable to most women when performed in the outpatient setting without analgesia and offers a suitable alternative to rigid hysteroscopy.
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