Impact of the clinical process on outcomes of menstrual disorders

Introduction: Menstrual disorders have a significant impact on the health and well being of women. There are wide, unexplained variations in treatment and investigation in primary care. Rates of referral to secondary care, where surgery is a more likely outcome, also vary. Aim: To examine the outcomes of a new model of care for women with menstrual disorders, known as the Bridges Project, involving implementation of an evidence based, GP led pathway of care integrated across primary and secondary sectors. Study Design: A prospective non-random comparison of two services: women attending the Bridges pathway and those attending a consultant-led one-stop menstrual clinic (OSMC). Outcomes were assessed after eight months and included treatment modalities, health status (SF-36 and menstrual questionnaire), an investigation of patient experience of care using the Patient Career Diary (PCD) and qualitative interviews, resource use and cost, adherence to guidelines and patient preferences for care. Setting: A large teaching hospital and one Primary Care Trust (PCT). Results: Between March 2002 to June 2004, 99 women in the Bridges pathway were compared to 94 women attending the OSMC. There were no statistically significant differences in mode of treatment or health status between them at eight months. Interviews demonstrated that women experience significant problems when accessing care for menstrual disorders and perceive their problems to be of low priority within the health service. The PCD demonstrated statistically significant differences for the Bridges group in several aspects of care: information and ease of access (P<0.001), choice of doctor (P = 0.020), waiting time (P<0.001), and sense of co-ordination between sectors (P< 0.001). There were significantly fewer outpatient appointments in the Bridges scheme (PO.001) with no increase in primary care workload. The cost per patient for the Bridges project was £751.72 compared to £1022.54 in the OSMC group. Conclusion: Although there were no differences between groups in the types of treatment (conservative, medical or surgical) women received, the new model of care resulted in significant improvements in patients' experiences of care whilst maintaining clinical quality at reduced cost through more efficient resource use.