Forum
ICGP AGM
Study shows poor
public access to
diagnostics
A new College study shows that GPs have poor direct
access to diagnostic tests for public patients, and reveals
a two-tier waiting list system. Niall Hunter reports
A study carried out by the College has found poor levels
of direct access for GPs to diagnostic testing in public
hospitals and long waits for public patients for these tests
compared to their private counterparts.
The study, presented at the recent AGM in Galway,
involved a postal survey of a sample of GPs on the ICGP
membership database, in which GPs were asked about their
level of access to diagnostic testing for their public and
private patients. The response rate was 58.4% (n=292).
The findings outlined the stark contrast between direct
access to diagnostics for public and private patients.
The key findings were:
• More than 20% of GPs do not have direct access to either
abdominal or pelvic ultrasound in the public system.
Where access is available, public patients have an average 14-week waiting period, but this varied from one day
to 42 weeks depending on location. In stark contrast, in
the private system, virtually all GPs have direct access
to ultrasound, with an average wait of just over four days
• In the public system, 70-80% of GPs have no direct
access to CT scans. Even where it is available, there is
an average 16 week wait, but this varied from less than
one week to 48 weeks. In the private system, 90% of GPs
have access to CT scanning, with an average waiting time
of 5.5 working days
• Approximately 10% of GPs have direct access to MRI
scans in the public system. The average wait for these
scans in the public system is 22 weeks, but this varies
from six days to 72 weeks. Virtually all GPs have direct
access to MRI scanning in the private system
• One quarter of GPs do not have direct access to DEXA
scanning in the public system and where available, the
average wait was 24 weeks, compared to less than seven
working days in the private system
• Direct access to gastroscopy, the study found, was available to 64% of GPs in the public system, with 57% having
direct access to colonoscopy, while 85% have access to
this testing in the private sector. There is a 12-week waiting list in the public sector compared to 12 days in the
private system.
The majority (86%) of respondents to the survey felt that
increased access to diagnostics would reduce their referrals
to emergency departments and improve the quality of their
referrals.
20 FORUM June 2013
When questioned about referrals to outpatient departments, 90% felt that improved access to diagnostics would
reduce their referrals to outpatients, and 92% felt this
would improve the quality of their referrals. Overall, 87%
believed that improved access to diagnostics would reduce
unnecessary admissions.
The study recommends:
• Increasing access to diagnostics for GPs for public patients
• Introducing national referral guidelines for access to
diagnostics to be developed using a partnership approach
between primary and secondary care
• Providing enhanced education for GPs on the use of referral guidelines
• Developing structured referral forms which are integrated
into GP software systems
• Providing rapid results of investigations to GPs
• Monitoring and auditing the new system and provide feedback to GPs.
The study was carried out by Margaret O’Riordan,
ICGP medical director; Dr Claire Collins, ICGP director of
research; and Gillian Doran, ICGP librarian.
Commenting on the findings, Margaret O’Riordan said
in all services, access to diagnostics for public patient is
unacceptably long and there is no doubt that as a result,
GPs are forced to refer patients inappropriately to overcrowded emergency departments.
“This can be an unnecessarily traumatic experience, particularly for elderly patients, and it places an extra costly
burden on hospital services. Patient access should be on
the basis of need and not on ability to pay.”
She added that GPs are highly trained specialists who are
currently constrained in the delivery of a quality service to
patients due to limited access to diagnostics in the public
system.
Dr O’Riordan said Irish GPs believe and international
evidence concurs that increased access to diagnostics will
lead to reduction in diagnostic delay, reduce the number of
referrals to both EDs and OPDs, reduce unnecessary admissions and improve the quality of referrals overall.
“This in turn will lead to more effective use of the hospital services and improve the quality of service for Irish
patients.”
The full results of the study are available on the College
website, www.icgp.ie
Forum
ICGP AGM
Getting animated about
developing world health
Tom O’Callaghan, in this year’s Foundation Lecture, outlined a unique Irish
initiative to deliver vital healthcare training in developing countries
This year’s Foundation Lecture at the AGM presented
the audience with a stark fact – there are one billion people
on the planet who will never see any health worker in their
lives. What’s more, there are nine million children who die
each year from simple treatable and preventable conditions
such as pneumonia and malaria.
Co Cork GP Dr Tom O’Callaghan, who delivered the lecture, focused on how the rapidly advancing development of
digital technology, coupled with medical and educational
expertise from Ireland and other countries, can be used to
improve healthcare provision in the developing world.
He pointed out that the current explosion in technological
change is probably as important an event in world history
as the Industrial Revolution, covering IT devices, social
networks, cloud computing etc. Many of these changes are
benefiting healthcare provision and education. There are now
new ways of reaching people with online medical education
that could not have been imagined even five years ago, he
said. “All this new technology means this will be a time of
enormous change in healthcare delivery. This is a real chance
for us to get to the bottom of the pyramid where people really
need access to healthcare in the developing world.”
A key to providing better healthcare in the developing
world is finding new ways to educate healthcare workers.
A university can now put a course online and someone
in India can complete it and have it examined within the
network, he said. While there is an urgent need to create
additional healthcare worker posts in the developing world,
Dr O’Callaghan said we can’t build the medical schools fast
enough, or train doctors or nurses quickly enough.
In sub-Saharan Africa over the past 20 years, some progress has been made in training community healthcare
workers to give then simple diagnostic tools to carry out
basic healthcare tasks, such as looking after people with
malaria or childhood pneumonia, and providing basic
antenatal care. Training in basic healthcare skills can be
provided at a fraction of the cost it takes to train a doctor
or a nurse, in a much shorter time and without having to
provide the infrastructure of medical schools etc.
But, Dr O’Callaghan pointed out, the current training
capacity to provide badly-needed community health workers
in developing countries is limited. He outlined his involvement in establishing iheed (www.iheed.org), an Irish global
health education initiative. This is a not-for-profit organisation aimed at providing innovative technological solutions
to training healthcare staff in the developing world.
iheed provides digital animation training content and is
developing blended training programmes for health workers
using mobile technology. Last year it carried out a study on
the current training of community
healthcare workers in sub-Saharan
Africa. It found
that of around
341,000 people
being trained,
only 4% used any
multimedia in
training. Most are
being trained with
books in a formal
classroom structure, even though
many are semiliterate or have
no formal educa- Tom O’Callaghan – urgent need for additional
healthcare workers in the developing world
tion. The training
involves the use of lengthy training manuals with dense and
difficult-to-digest information. However, transferring this
information to a digital base would be very time-consuming.
The organisation, iheed identified an opportunity to
reduce the cost of training by up to 75% by introducing
focused multimedia training. There was a particular need,
Dr O’Callaghan said, to introduce the type of training where
people won’t have to be taken out of the field and into
classrooms for long periods, but kept in their community
where they are needed while remaining connected with continuing professional education.
iheed brought together educators, technology companies
and NGOs from around the world to put together a multimedia educational programme using animation, having trawled
studios around the world to hire animators for the project.
The project is helped by the high usage of mobile devices
and smartphones in the developing world. The programme
uses simple two-minute animated clips to teach basic
healthcare skills to community health workers. The content
is reviewed by a medical team. The animation is being made
available to any NGO that wishes to use it and is now being
used in the field in developing countries.
The value of using animated content is that it can overcome local geographical and cultural issues, and can be
dubbed into different languages. He believed the content
was much more engaging for students than simply reading books or PDFs. It will help provide quick, simple and
cost-effective training to help meet the massive healthcare
needs of developing countries, Dr O’Callaghan said.
– Niall Hunter
FORUM June 2013 21