Establishment and feasibility of community-based general-practitioner-led cardiology clinics

Abstract

Background: Community-based general practitioner (GP) cardiology clinics (locality clinics) offer an alternative to hospital-based cardiology clinics. In the Greenwich area, four GPs were trained for 3 months in cardiology, followed by another 3 months in a hospital out-patient clinic. GPs then established cardiology clinics in their practices and continued to act as hospital clinical assistants on an alternate-week basis. Aim: To assess referral and investigation patterns for the locality clinics over their first 3 years. Design: Pilot study, retrospective case-note audit. Methods: We analysed 125 sets of notes selected at random from the locality and the hospital clinics, and compared them. Results: There were no differences in demographics or the indication for referral between locality and hospital clinics, and despite the small sample size, no major differences in referral and investigation patterns. In both clinics, ∼ 83% of patients had at least one cardiac investigation, and ∼ 63% were discharged after initial consultation. Some 10% of locality patients were referred for follow-up in the hospital clinic. Beta-blockers were prescribed more by hospital doctors (14% vs. 3%), with no significant difference in other cardiac medications. Coronary risk factors were more often recorded in the notes of locality patients. Discussion: Establishing community-based GP cardiology clinics seems feasible, and these clinics may be the way forward for enhancing cardiac care in the community.