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Research and Projects

Systematic review of patient-initiated clinics (PIC) in secondary care for people with chronic disease

Theme: CLAHRC - Person-Centred Care
Status: Live

This review is being led by the Evidence Synthesis Team.


Missed hospital appointments are reported to cost the UK National Health Service millions of pounds every year. Alternative methods of appointment scheduling with improved flexibility have been developed. Some examples of this are the Choose and Book service implemented in 2004 and the Expert Patient Programme courses implemented in 2006. The Expert Patient Programme aimed to help people with long term conditions develop skills and confidence to self-manage their condition and make more effective use of healthcare services. Other strategies commonly used to improve appointment attendance include over-booking, fines for missed appointments and appointment reminder systems; these strategies are less responsive to patient need.

In 2002 the World Health Organisation published a report which highlighted the need for a model of care that more readily meets the needs of people with chronic conditions. The authors of the report suggested that innovations that build on evidence-based decision-making, have a population and quality focus and are flexible to the needs and demands of the patient population should do well in improving the management of chronic conditions for the healthcare system and the people that use it. 

In contrast to a traditional appointment system, a patient-initiated clinic (PIC) system aims to be responsive to patient need.  Routine appointments are not regularly scheduled by the physician.  An example of how this might work in practice is, if a patient is experiencing an exacerbation of their condition, they can phone an advice line manned by a specialist nurse, and where necessary a consultant appointment is arranged as soon as possible.

Project aims and objectives

The objective of this Cochrane review is to systematically review the evidence for a PIC system in secondary care for patients with chronic or recurrent conditions.  In particular we are interested in whether these clinics can effectively manage conditions without causing clinical harm to patients and whether resource use can be reduced in comparison to usual care. 

Further information

For more information, read the protocol.

To discuss this further contact Rebecca Whear via email.

Others Involved

Lindsey Anderson