Specialist Appointments Research Articles

1076 Online Availability of Hand Splints for Patients with Common Upper Limb Nerve Entrapment Syndromes During COVID-19 Pandemic

AimSplinting is first line treatment in mild to moderate cases of carpal and cubital tunnel syndrome. During COVID-19 lockdown, patients experience prolonged waiting time for their splints from specialist service if not requiring surgery. Many of our patients have not trialled splinting prior to their specialist appointments. We aimed to look at the quality of splints commercially available for the general public to purchase thereby starting treatment earlier.MethodHand splints for nerve entrapment are readily available through two of the biggest UK online retailers, Amazon.co.uk and eBay.co.uk. We searched the terms ‘carpal’ and ‘cubital’ tunnel splints on both sites, the top 5 results were assessed for their suitability, accessibility, and affordability.ResultsThe average cost of splints for carpal tunnel syndrome on Amazon and eBay are £9 and £8 respectively, and £15 on Amazon and £10 on eBay for cubital tunnel syndrome. We found that all top 5 hand splints found on these websites are suitable for the conditions they advertised. The average time for free delivery of splints is 2 days for Amazon and 3 days for eBay. Splints are easily sized by using the sellers wrist/elbow circumference measurement guide.ConclusionsThis study has given us the confidence to encourage patients to purchase splints, at an affordable price, from online sites whilst either waiting for specialist appointments or as part of their specialist recommended treatment. With early initiation of treatment, patients may have symptomatic relief and, in some cases, avoid the need for further treatment, leading to reduced hospital footfall.

When do physicians perceive the success of a new care model differently?

BackgroundThe health care innovation “MamBo – people with multimorbidity in outpatient care: patient-focused and needs-oriented healthcare management” aims to improve the efficiency and quality of care for multimorbid patients by delegating tasks (e.g. taking over house calls or coordinating specialist appointments) to a monitoring and coordination assistant (MoniKa). Participating physicians are very important for the success of the health care innovation due to their direct involvement as practitioners and their task of enrolling patients. The aim of this part of the evaluation study is therefore to identify the physicians’ personal values, which influence the individual perception of the project’s advantages and thus possibly the acceptance and sustainable implementation of new care structures.MethodsTwo Focus groups (n = 4; n = 6) and three individual interviews with general practitioners and specialists who decided to implement the health care innovation within the first year were conducted. The semi-structured guidelines were developed by the research team. The interviews were analysed according to the content analysis by Mayring. We used the learning model of operant conditioning to place our study results in a theoretical context.ResultTwo central personal values of the participants, which determine the desired advantages of the health care innovation were identified: More patient-oriented and more economic-oriented values. Participants with more patient-oriented values quickly perceived advantages, which seems to be beneficial for the acceptance of the new care structures. Economic-oriented participants tended to be more critical. The benefits of the health care innovation, which was expressed, for example, in an improvement of the practice routine, has not yet been perceived by this group, or only to a limited extent.ConclusionsThe results suggest that the respective values of the participants define the individual perceived advantages and thus, the assessment of the success of the health care innovation in general. These findings could be used in the implementation process by increasing the motivation of the project participants through typified supervision.Trial registrationThe study has been registered in the German Clinical Trials Register (DRKS00014047).

The right to health in the territory: service users' perceptions of Primary Health Care.

Primary health care is an essential component of effective health systems. The aim of this study aim was to evaluate the quality of primary care in a city in the state of Pernambuco, Brazil. We conducted an exploratory study with 525 service users using structured questionnaires. The quality of primary care was assessed across five dimensions: accessibility, clinical care, professional-user relations, community activities and structure. The findings point to the perpetuation of social vulnerabilities and challenges in achieving equitable universal care. Dissatisfaction rates were highest in the following categories: access to specialist appointments and exams, appointment wait time, and opportunity to make complaints. However, respondents were satisfied with medical and nursing care, particularly in relation to respect, privacy, listening and confidentiality. The findings show that, although health professionals were committed to providing humanized care, fragmentation of care is evident, hampering the provision of adequate and timely follow-up and negatively affecting the quality of care.

Appointment Service Centres for Specialist Medical Appointments: How Effective are they?

To reduce outpatient specialist waiting times and to help patients with statutory health insurance to get appointments and urgent referrals within four weeks, phone appointment service centres (ASC) were introduced in Germany in January 2016. The aim of this study was to analyse these booking patterns in the Westphalia-Lippe (WL) region, and to compare the types of regular specialist referrals with those made by the centers. Furthermore, neurology services to patients with ASC referrals were compared to those without. Appointment data from the second quarter of 2016 to the third quarter of 2019 were used, and an algorithm was developed to determine the range of services provided in appointments made by the ASCs. A total of 24,286,157 accounting slips were compared with 12,648 specialist service records from the Association of Statutory Health Insurance Physicians in the WL region. The average waiting time for an appointment with a specialist was 21 days for 84% of the callers with a referral (aged mostly 35-59 years). Requests for appointments with neurologists, internists, and radiologists were the most frequent ones; 45% of service centre specialist appointments were made with neurologists, despite these comprising only 4% of total referrals in WL. There were only a few differences in the use of services in neurologist appointments with and without the mediation of the ASC. The higher level of ASC used for making neurologist appointments for initial psychotherapeutic assessment was statistically significant. However, the effect was small. Despite its relatively low use (0.19% of specialist referrals in general), ASCs in the WL region are able to make urgent specialist appointments for patients with statutory insurance, with average waiting times significantly lower than the legally set maximum waiting period. However, patients also take other factors into account when making appointments. While the benefits of these centres, especially for three types of specialists, was demonstrated, further discussion on the form of the ASCs in their current form is warranted. This paper provides a basis for evaluation of methodology and content for further decision-making.

100 years of insulin-enormous gratitude for my extra 65 years!

My name is Peter Davies, and with this year being the one hundredth anniversary of insulin, it is a tremendous honour to be invited to write this account of my life with Diabetes.

The surveillance of systemic cancer therapy access amidst the COVID-19 pandemic: the power of good data.

The surveillance of systemic cancer therapy access amidst the COVID-19 pandemic: the power of good data.

A cannulated prolactin series reduces the need for further investigations in women with infertility and lowers the number of false positive screening prolactin measurements.

The prevalence of hyperprolactinaemia in women presenting for infertility investigation has been found to be up to 17%, and many of these women are asymptomatic. Prolactin levels may be elevated by stress, including phlebotomy and not be of clinical significance. A cannulated prolactin study may be a useful way to discriminate this. To determine the utility of a cannulated prolactin series in women presenting with infertility who have a raised prolactin measurement at referral for first fertility consultation. All women referred to two fertility centres had a prolactin level measured prior to first appointment over a two-year period. If the level remained elevated on the second measure after macroprolactin precipitation, women were referred for a cannulated prolactin series. If the prolactin concentration fell within the reference range during the series then the result was regarded as normal. Forty-four (2.7%) of 1660 women seen for a first specialist appointment had persistently raised prolactin concentrations after two samples and were referred for a cannulated series. The proportion of women whose prolactin was found to be normal during the cannulated prolactin series was 61% (95% CI 47-74%). Even in patients with a referral prolactin of greater than 1000mU/L, 45% had a normal two-hour cannulated series. A high proportion (61%) of women with raised prolactin at time of referral for first specialist appointment had a normal prolactin after a two-hour cannulated series. A cannulated prolactin study can avoid unnecessary further investigations in these women.

411 EFFICACY OF CDSS IN IMPROVING ANTI-RESORPTIVE BONE PROTECTIVE THERAPY AMONGST ORTHOGERIATRIC INPATIENTS: A COMPARISON STUDY

Abstract Background Hip fractures have a mortality rate of 20% in the year following the fracture. Therefore, patients presenting with hip fractures should be assessed and prescribed anti-resorptive bone protective therapy (ABPT) to reduce the risk of further fractures. In our institution, this decision is undertaken by a specialist only. Purpose: The objective of this study is to compare the proportion of patients commenced on ABPT by surgical interns following the introduction of a Clinical Decision Support System (CDSS) in January 2020 to support appropriate ABPT prescribing amongst non-specialists. Methods The study compares the orthogeriatric patient cohort before and after CDSS introduction within the same time period (Jan 1st to June 30th) in 2019 and 2020. Data were extracted from the Irish Hip Fracture Database and statistically analyzed using SPSS. The Mann–Whitney two-tailed test was employed to calculate statistical significance. Results In 2019, 31% (55/178) of patients admitted during the study period (n = 178) did not receive orthogeriatric specialist input and only 27% (15/55) of these had ABPT prescribed during their admission. In 2020, 17% (32/185) of patients admitted during the study period (n = 185) did not receive specialist input; however, 44% (14/32) of these were commenced on ABPT. Overall, more patients were prescribed ABPT in 2020 (78%;146/185), as compared to 55% (98/178) in 2019 (z-score 6.57069; p-value <0.01). The number of patients awaiting specialist outpatient appointments before being prescribed ABPT also dropped from 40% (71/178) in 2019 to 13% (24/185) in 2020 (p-value <0.01). Conclusion This study highlighted the significance of a CDSS to improve inpatient ABPT prescribing by non-specialists and to reduce outpatient specialist appointments. This could have a major impact on the long-term reduction of mortality rates amongst orthogeriatric patients and the reduction of future healthcare costs.

Sexual and reproductive health needs assessment & interventions in a female psychiatric intensive care unit

AimsTo assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments/interventions in this setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and interventions in the PICU.MethodA retrospective analysis of fifteen months’ activity data found that only 25 SRH referrals had been made across 205 PICU admissions. This low referral rate of 12% likely reflected pathway barriers and was unlikely to represent the actual clinical need in female PICU patients. A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought.ResultA quality improvement approach streamlined SRH assessments on the PICU and resulted in 42% of women being assessed and a 3.5-fold increase in uptake. At least 30% of the women in the PICU had unmet SRH needs identified and proceeded to a specialist appointment. This amounts to a minimum 2.5-fold increase in SRH unmet need detection.The most common SRH needs were complex gynaecological issues (such as period problems, pelvic pain, vaginal discharge), STI advice/testing and contraception advice/options. 21% of women initiated SRH interventions, and 14% completed all the interventions required for their needs. The most common interventions were in the areas of contraception advice/family planning and STI advice/testing.Staff confidence on assessing SRH topics was identified as a barrier to access with a positive shift noted after bespoke SRH training was implemented and a protocol introduced: on a scale of 0-10 (with 10 being high), 81.3% of staff rated their confidence 8 or above in relation to discussing contraception/sexually transmitted infections (pre-training: 25.0%), and 93.8% in relation to discussing risky behaviours (pre-training: 18.8%). All 11 patient and carer participants felt it was important to have a forum to talk about SRH and 8 (72.7%) agreed it was important in the PICU.ConclusionResults identify that SRH needs for PICU admissions are greater than previously realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient's individual risk profile considered. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients.

The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand–a country pursuing COVID-19 elimination

BackgroundThe COVID-19 pandemic has disrupted cancer services globally. New Zealand has pursued an elimination strategy to COVID-19, reducing (but not eliminating) this disruption. Early in the pandemic, our national Cancer Control Agency (Te Aho o Te Kahu) began monitoring and reporting on service access to inform national and regional decision-making. In this manuscript we use high-quality, national-level data to describe changes in cancer registrations, diagnosis and treatment over the course of New Zealand's response to COVID-19. MethodsData were sourced (2018–2020) from national collections, including cancer registrations, inpatient hospitalisations and outpatient events. Cancer registrations, diagnostic testing (gastrointestinal endoscopy), surgery (colorectal, lung and prostate surgeries), medical oncology access (first specialist appointments [FSAs] and intravenous chemotherapy attendances) and radiation oncology access (FSAs and megavoltage attendances) were extracted. Descriptive analyses of count data were performed, stratified by ethnicity (Indigenous Māori, Pacific Island, non-Māori/non-Pacific). FindingsCompared to 2018–2019, there was a 40% decline in cancer registrations during New Zealand's national shutdown in March-April 2020, increasing back to pre-shutdown levels over subsequent months. While there was a sharp decline in endoscopies, pre-shutdown volumes were achieved again by August. The impact on cancer surgery and medical oncology has been minimal, but there has been an 8% year-to-date decrease in radiation therapy attendances. With the exception of lung cancer, there is no evidence that existing inequities in service access between ethnic groups have been exacerbated by COVID-19. InterpretationThe impact of COVID-19 on cancer care in New Zealand has been largely mitigated. The New Zealand experience may provide other agencies or organisations with a sense of the impact of the COVID-19 pandemic on cancer services within a country that has actively pursued elimination of COVID-19. FundingData were provided by New Zealand's Ministry of Health, and analyses completed by Te Aho o Te Kahu staff.

Leveraging Telehealth for Delivery of Palliative Care to Remote Communities: A Rapid Review.

Background: Palliative care encompasses supportive health care for patients at any stage of illness aimed at relieving symptoms, controlling pain, managing stress, offering respite for caregivers, and optimizing the quality of life. Objective: To explore strategies for increasing access to palliative care among individuals living in remote/rural communities, a rapid review was conducted on studies that explored the use of telehealth applications with this population. Methods: From December 2019 to February 2020, the PRISMA methodology was used to gather peer-reviewed studies published in the English language. MedLine, Google Scholar, and EBSCO were searched; no date limitations were set. Given the diversity of study methodologies and outcomes, the findings were synthesized narratively. The Cochrane Collaboration's tool for assessing the risk of bias was also employed. Lastly, the studies were mapped to clinical guidelines for the various aspects of quality palliative care. Results: The 18 studies found, published between 2004 and 2019, were conducted in seven countries and on five continents. Aims included evaluating feasibility, efficacy, and user satisfaction. Insights draw from a combined pool of 3,313 patients and 250 providers. Most studies involved oncology patients and employed videoconferencing or a web platform/online software with videoconferencing. Three themes emerged: delivery of care, symptom management and quality of life, and patient/caregiver/provider satisfaction levels. Telehealth proved effective for patient and medication monitoring, provider and specialist appointments, and palliative care consultations. Operational benefits included clinician time saved, shorter appointment wait times, and reduced no show rates; implementation challenges also emerged. Statistical improvements in quality of life and symptom management were reported. Nearly two-thirds of the studies reported positive experiences among patients, caregivers, and providers; about half included an interprofessional team. The studies primarily focused on the structure/process and physical aspects of quality palliative care, there was a paucity of insights on the spiritual, cultural, end of life, and ethical/legal aspects of care. Two-thirds (12/18) of the studies employed a descriptive design. Risk for selection, performance, detection, and reporting biases emerged for all the studies; for example, only four of the studies included control groups and less than 20% (3/18) reported on attrition of study participants. Additional limitations include the rapid review methodology which relied heavily on the lead author's decisions and the restriction of studies published only in the English language. Conclusion: More rigorous research is required to confirm the viability of clinical care delivery and establish best practices for quality, virtual palliative care to remote/rural areas.

A183 TELEHEALTH USE IN RURAL SASKATCHEWAN AND INFLAMMATORY BOWEL DISEASE OUTCOMES

BackgroundAppropriate management of inflammatory bowel disease (IBD) often requires multiple specialist appointments per year. Living in rural locations may pose a barrier to regular specialist care. Saskatchewan (SK) has a large rural population. Prior to COVID-19, telehealth (TH) in SK was not routinely used for either patient assessment or follow up. Furthermore, TH was exclusively between hospitals and specific TH sites without direct contact using patient’s personal phones.AimsThe objective of this study was to assess the differences in demographics, disease characteristics, outcomes, and health care utilization between patients from rural SK with IBD who used TH and those who did not.MethodsA retrospective chart review was completed on all rural patients (postal code S0*) with IBD in SK who were followed at the Multidisciplinary IBD Clinic in Saskatoon between January 2018 and February 2020. Patients were classified as using TH if they had ever used it. Information on demographics, disease characteristics, and access to IBD-related health care in the year prior to their last IBD clinic visit or endoscopy was collected. Data was not collected for clinic visits after March 1, 2020 as all outpatient care became remote secondary to the COVID-19 pandemic. Mean, standard deviations, median and interquartile ranges (IQR) were reported. Mann-Witney U and Chi-Square tests were used to determine differences between the groups.ResultsIn total, 288 rural SK IBD patients were included, 30 (10.4%) used TH and 258 (89.6%) did not. Patient demographics were not significantly different between the two groups; although, there was a statistically significant difference in the proportion of ulcerative colitis patients (17% TH vs. 38% non-TH, p=0.02). The percentage of patients with clinical remission was 87% for TH patients and 74% for non-TH patients (p=0.13). There were no significant differences in health care utilization patterns and biochemical markers of disease, including c-reactive protein (CRP) and fecal calprotectin (FCP) (p>0.05).ConclusionsPrior to the pandemic, a small percentage of patients with IBD in rural SK ever used TH. A small proportion of UC patients used TH. No significant differences in disease characteristics, outcomes, or health care utilization were identified. Further study is warranted to identify barriers to use of this technology to tailor care to this patient group and improve access to care, especially now as the COVID-19 pandemic has drastically changed the use of virtual care.Telehealth (n=30)Non-Telehealth (n=258)P-valueHarvey-Bradshaw Index, median (IQR)2(0.25–4)1(0–4.25)0.62Partial Mayo Score, median (IQR)0(0–0.25)0(0–2)0.14CRP<5, n(%)23(79)176(72)0.38FCP<50, n(%)9(47)52(29)0.12Clinical Remission, n(%)26(87)191(74)0.13Clinic visits within the last 12 months, median (IQR)2 (1–2.25)2 (1–3)0.18Funding AgenciesNone

Cultural, social, and healthcare access factors associated with delays in gastric cancer presentation, diagnosis, and treatment: A cross-sectional study

BackgroundThe aim of this study was to identify the time intervals between the demand for health services and the initiation of cancer treatment, and to explore the associated factors, in gastric cancer patients being treated in an oncology hospital in northern Brazil. MethodsThis cross-sectional study. Gastric cancer patients receiving treatment in a northern Brazil reference hospital were interviewed. A Mann-Whitney test was used to verify associations between the time intervals of access to treatment and socioeconomic factors, clinical variables, and patient difficulties, adopting a 0.05 significance level. ResultsThe average time intervals were 471.3 days between symptom onset and primary health service request and 180.9 days between diagnosis and treatment. The average time between the onset of symptoms and the treatment of gastric cancer was 747.8 days. Patients using herbal home remedies showed the longest times before seeking primary health care (p = 0.04). Delays between diagnosis and treatment were associated with unemployment (p = 0.03). High average times until oncologist appointments were related to the absence of comorbidities (p = 0.004). Personal difficulties and a lack of hospital beds were associated with long time intervals to specialist appointments and between diagnosis and treatment. Personal difficulties were associated with long time intervals between the onset of symptoms and the treatment of gastric cancer. ConclusionGastric cancer patients faced delays and healthcare access barriers in a region with high mortality for this disease. Appropriate interventions are necessary to reduce delays and better control the disease. Policy SummaryIn this paper we have explored the barriers to access to diagnosis and treatment for patients with gastric cancer in a major cancer centre in Northern Brazil. The results will inform strategies for improving timely access to critical cancer services.

Findings From a Commercial ACO Patient Experience Survey.

Accountable care organizations (ACO) emerge each year aiming to improve care quality while controlling rising health care costs. This cross-sectional study examined whether ACO arrangements within a Preferred Provider Organization and a Health Maintenance Organization (HMO) effected patient experience. A modified Consumer Assessment of Healthcare Providers and Systems ACO survey was used to assess care domain differences overall and by product. The association between ACO and non-ACO populations and items in each significant care domain, flu vaccination, and delayed and emergency department care are explored using multivariable logistic regression. Accountable care organizations patients were more likely to report it was easy to get a specialist appointment (adjusted odds ratio [AOR], 1.54; 95% CI = 1.11-2.13), less likely to report visiting the emergency department for care (AOR, 0.70; 95% CI = 0.55-0.90) and communicating with their provider using technology (AOR, 0.79; 95% CI = 0.65-0.96). Reported experience differed for Access to Specialists between ACO and non-ACO groups among overall and HMO respondents (79.4% vs 74.7% and 79.9% vs 75.5%, P < .05, respectively). The ACO patient experience was not substantially better. Strategies incorporating satisfaction and experience, whether linked to contracts or not, should be encouraged given ACOs goal to optimize patient care. Survey instruments must be improved to capture nuances of provider care and patient bond that is vital in ACO integrated systems.

Impact of COVID-19 lockdown in children with neurological disorders in Italy

BackgroundThe costs and benefits of full lockdown measures are debated. Neurologically impaired children are a vulnerable population with specific needs in terms of protection against infection and access to health services. ObjectivesWe investigated the effects of lockdown on the health of children with neurological disorders and on their access to care during lockdown. MethodsData from 514 children (282 males – 232 females) were collected through physician-administered interviews to investigate: the occurrence of viral-like physical symptoms, the correlation between the risk of developing such symptoms and several demographic and clinical variables, the occurrence of any worsening of the children's neurological conditions during lockdown, and their access to care services during this period. Results49.1% experienced at least one symptom during the study period, but no child developed severe complications. The prevalence of symptoms was significantly lower during lockdown than during the previous two months. The underlying neurological condition worsened in 11.5% of the patients. Children who regularly left the home during lockdown were greater risk of exhibiting symptoms. During lockdown, 67.7% had a specialist appointment cancelled, 52.6% contacted their paediatrician, and 30.9% contacted their child neuropsychiatrist. Among patients who usually receive rehabilitation, 49.5% continued remotely. ConclusionLockdown protected children from infections. Telemedicine and telerehabilitation constituted a valid alternative for the care and treatment of these children, but they should not become a widespread and definitive model of care. COVID-19 and other emergency response plans must take into account the specific needs of children with disabilities.

Comparison of self-report and administrative data sources to capture health care resource use in people with chronic obstructive pulmonary disease following pulmonary rehabilitation

BackgroundThe optimal method to collect accurate healthcare utilisation data in people with chronic obstructive pulmonary disease (COPD) is not well established. The aim of this study was to determine feasibility and compare self-report and administrative data sources to capture health care resource use in people with COPD for 12 months following pulmonary rehabilitation.MethodsThis is a secondary analysis of a randomised controlled equivalence trial comparing centre-based and home-based pulmonary rehabilitation. Healthcare utilisation data were collected for 12 months following pulmonary rehabilitation from self-report (monthly telephone questionnaires and diaries) and administrative sources (Medicare Benefits Schedule, medical records). Feasibility was assessed by the proportion of self-reports completed and accuracy was established using month-by-month and per participant comparison of self-reports with administrative data.ResultsData were available for 145/163 eligible study participants (89%, mean age 69 (SD 9) years, mean forced expiratory volume in 1 s 51 (SD 19) % predicted; n = 83 male). For 1725 months where data collection was possible, 1160 (67%) telephone questionnaires and 331 (19%) diaries were completed. Accuracy of recall varied according to type of health care encounter and self-report method, being higher for telephone questionnaire report of emergency department presentation (Kappa 0.656, p < 0.001; specificity 99%, sensitivity 59%) and hospital admission (Kappa 0.669, p < 0.001; specificity 97%, sensitivity 68%) and lower for general practitioner (Kappa 0.400, p < 0.001; specificity 62%, sensitivity 78%) and medical specialist appointments (Kappa 0.458, p < 0.001; specificity 88%, sensitivity 58%). A wide variety of non-medical encounters were reported (allied health and nursing) which were not captured in administrative data.ConclusionFor self-reported methods of healthcare utilisation in people with COPD following pulmonary rehabilitation, monthly telephone questionnaires were more frequently completed and more accurate than diaries. Compared to administrative records, self-reports of emergency department presentations and inpatient admissions were more accurate than for general practitioner and medical specialist appointments.Trial registrationNCT01423227 at clinicaltrials.gov

Workforce intelligence: what data do we need to collect to understand trends in substantive oral and maxillofacial surgery consultant posts? A retrospective review and plan for the future.

Understanding workforce pressures within surgery is an inexact science. This paper assembles evidence regarding oral and maxillofacial surgery (OMFS) consultant appointments in the UK and plans for prospective data collection in the future. Information about the number of OMFS specialists joining the UK specialist list was obtained from the General Medical Council and compared to a database of substantive OMFS consultant posts. OMFS consultants were asked to contribute information about their training programmes and consultant appointments (date, interview experience, and sub-specialty interest). This information was collated on Excel© and analysed using WinStat©. Data on OMFS consultant posts advertised in 'NHS Jobs' and the British Medical Journal were collected. The mean (SD) number of specialists joining the specialist list per year is 24.1 (5.2) with a median of 24 and a range of 15 - 36. The number of trainees completing training and numbers joining the OMFS specialist list are in balance at present. The median delay between OMFS specialist listing and appointment as a consultant was 72 days and mean of 169 with the 25th centile of five days, standard deviation of 239 days and maximum of 5.2 years. Of those returning data, 135 (47%) candidates were the sole interviewee and 83 (29%) had one other candidate at their successful interview. The mean application ratio for each post was 1.9 and the median number of candidates was one, mean 1.6 and maximum candidates seven. About half of the posts were filled by trainees from their regional training rotation. Prospective data collection on advertised posts, interviews held, expected retirements/new posts, combined with a route for trainees approaching CCT to highlight their availability may streamline recruitment and allow a more rapid recognition of recruitment problems.

Reducing time between referral and diagnosis in paediatric outpatient neurodevelopmental and behavioural clinics.

This study investigated the impact of a transdisciplinary advanced allied health practitioner (AAHP) in a public hospital general paediatric outpatient department for children referred for concerns with neurodevelopment, learning and/or behaviour. It was hypothesised that time from referral to initial consultation and diagnosis was reduced for children initially assessed by AAHP. It was also hypothesised that children seen by AAHP were less likely to require a medical specialist appointment. De-identifiable data were gathered from hospital records both retrospectively and prospectively for each group. Data were collected from: 75 children who attended a medical consultation only clinic in 2014; 75 children who attended an AAHP clinic and a medical officer in 2014 and 75 children who attended an AAHP clinic and a medical officer 2 years after establishment in 2016/2017. On average, 52% children were managed independently by the AAHP. Wait time from referral to consultation significantly decreased from 169 days to 48 days. Similarly, time from referral to diagnosis significantly reduced by almost a half, from 57.2 to 30.59 weeks. This study provides preliminary evidence that utilisation of transdisciplinary AAHPs in general paediatric outpatient departments may reduce waitlists, reduce amount of medical specialist appointments required and provide earlier diagnosis for children with neurodevelopmental, behavioural and/or learning difficulties.

Restructuring an academic dermatology practice during the COVID-19 pandemic.

Severe acute respiratory syndrome coronavirus 2 is a highly virulent positive‐sense single stranded RNA virus that spreads rapidly via respiratory droplets, causing severe acute respiratory syndromes with significant mortality and morbidity. Currently 210 countries and territories are affected around the world with a reported 2.6 million confirmed cases. The coronavirus disease 2019 pandemic has changed the way patients attend their specialist appointments and receive medical care. While some specialist clinics have closed we have implemented strategies and restructured our academic practice in Australia to minimize the spread of disease while treating patients who need urgent care. We hope to share these strategies in the hope they may be useful to the dermatology community.

A novel methodology to measure waiting times for community-based specialist care in a public healthcare system

BackgroundMonitoring waiting time (WT) in healthcare systems is essential, since long WT are associated with adverse health outcomes, reduced patient satisfaction and increased private financing. ObjectiveTo describe a methodology developed for routine national monitoring of WT for community-based non-urgent specialist appointments, in a public healthcare system. MethodsThe methodology is based on data from computerized appointment scheduling systems of all Health Maintenance Organizations (HMOs) in Israel. Data included first 50 available appointments for community-based specialists and actual number of visits. Five most frequent specialties: orthopedics, ophthalmology, gynecology, dermatology and otolaryngology, were included.WT offered to HMO members for non-urgent care was calculated for two scenarios: "specific" physician and "any" physician in the region. Distribution of offered WT was calculated separately for each specialty and geographical region, combined to create the nationwide distribution. ResultsThe methodology was tested on data extracted between December 2018-June 2019. Estimated national median WT for "specific" physician, ranged from 9 days (ophthalmology/gynecology) to 20 days (dermatology), with large variation between geographic regions. WT were 26–56 % shorter for "any" than for "specific" physician. ConclusionsThis novel method offers a solution for ongoing national WT measurement, using computerized scheduling systems. It integrates two scenarios for appointment scheduling and allows identification of differences between specialties and regions, setting the ground for interventions to strengthen public healthcare systems.