Direct access to diagnostic services

Abstract

However, even well developed evidencebased guidelines are often not used in day-today care (estimations range from 25-50%). There are different causes for clinical guidelines not being used, partly related to the guidelines themselves. For instance, some guidelines are written as a handbook on a clinical topic and not as a concise set of concrete recommendations for decisions in day-to-day practice. They often have too many recommendations, making it difficult for the user to identify the key-issues and most important targets. Many do not answer the crucial questions of patients and practitioners related to the health problem well, as outlined by Hegarty et al.

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

“…51 The limited uptake of direct access by GPs highlights a need to engage GPs in the planning and implementation of new services. 427 Direct access may result in reduced waiting times from presentation to testing and treatment. 427 A review found that direct access to diagnostic tests allows GPs to manage a substantial number of patients who would otherwise have been referred to the hospital outpatient department.…”

“…427 Direct access may result in reduced waiting times from presentation to testing and treatment. 427 A review found that direct access to diagnostic tests allows GPs to manage a substantial number of patients who would otherwise have been referred to the hospital outpatient department. 428 Limited information is available on costing associated with increased access to diagnostics for GPs versus hospital-based access only.…”

No more neurophobia: welcome neurology in general practice

“…6 The second study (296 recruited) reported a positive outcome, 7 but this result was compromised by a number of serious methodological flaws, including an inadequate randomisation procedure, single blind design, and a 25% drop out rate (not included in the analyses). 8 Following the publication of these three trials in 2007, 4,6,7 some commentators still recommended the use valaciclovir for those with severe facial weakness, 9,10 despite the evidence of lack of effectiveness. Most recently, the Swedish study 5 has hopefully put the matter beyond doubt, with no evidence that valaciclovir was effective in the management of Bell's palsy.…”

“…After decades of little persuasive evidence, four randomised controlled trials, involving over 1800 patients, have recently been published, and their results allow much more robust conclusions regarding drug treatment of Bell's palsy. [4][5][6][7] Steroids definitely improve outcome, based on the results of two large primary care based trials which addressed this question. The Scottish Bell's palsy trial 4 included 551 patients recruited from primary care, and showed that 83% of patients treated with prednisolone within 72 hours of onset (50 mg/day for 10 days) had recovered compared to 63.6% who received placebo at 3 months (number needed to treat [NNT] = 6) and this result remained significant at 9 months (NNT = 8).…”

“…We have shown that GPs with special interests (GPwSIs) can satisfy patients with migraine more than specialists and at a lower price. 6 GPs in many areas already have direct access to scanning, but as in other specialist areas, 7 GPs may be reluctant to use direct access. The greater resolution and discrimination of magnetic resonance imaging (MRI) is attractive to neurologists, but frequent non-specific findings confuse doctors not used to MRI reporting.…”