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Integrating care in Irish paediatric dermatology services: an analysis of GP experiences

Authors:

Nicole Fagan ,

St. James’s Hospital, Ireland, IE
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Veronika Dvorakova,

IE
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Maeve McAleer,

IE
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Fiona Browne,

IE
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Alan D. Irvine,

IE
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Áine Carroll

IE
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Abstract

Introduction

Children should have access to safe, local, child centred and high quality services within an

appropriate timeframe. In Ireland dermatology services are overburdened and children can be

waiting >3 years for a first appointment. Many referrals could be dealt with locally in primary care

if additional supports, education and clear integrated clinical pathways were available. As GPs are

the gatekeepers to secondary care their opinions are key when identifying the root cause of

challenges faced and considering interventions that would strengthen the relationship between

primary and secondary care. Thus, facilitating more integrated care for children.

Theory/ Methods

This cross sectional study investigated GP and GP trainees experiences of referring to paediatric

dermatology services and explored interventions. A unique online questionnaire based off the

literature was designed with key stakeholders and distributed to participants. Qualitative themes

were identified using Braun and Clarke methodology.

Results

Of 206 respondents (GPs=162, trainees=44), 75% were urban based and 25% rural. The majority

had >20years experience. Interestingly, 43% felt they did not have access to appropriate resources

in the community and 79% felt they had not received enough training. Despite over 50% not having

an interest in dermatology, 67% wanted to manage chronic skin disease in children. Integrated care

pathways were the most desired intervention, with 95% feeling this would be of benefit for their

practice. Most respondents wanted more education (92%) and national guidelines (88%). From the

open ended questions 16 codes were identified and 4 major themes emerged. The theme ‘Barriers

to Access’ encompassed codes relating to long waiting lists, geographical location and funding.

‘Teledermatology’ included comments relating to phone and virtual patient clinics. The theme

‘Education’ included guidelines, training, and further resources. Finally ‘Collaboration’ incorporated

comments regarding specialist nurses and follow up as well as remote support for GPs.

Discussion

Many GPs have a desire to care for their patients in the community and could be supported remotely

by specialist services. Although it would take time and resources to implement these interventions,

secondary care services would benefit as it would allow more time to see complex cases suitable

for a tertiary level facility.

Conclusion

The findings of this study show clear clinical pathways, more training and recognised guidelines

would be well received. Treating children closer to home would be expected to lead to a reduction

in referrals and allow patients to be seen in a more timely and cost effective manner, thus benefiting

children and families.

Lessons learned

Paediatric dermatology is a service that would benefit from an integrated care approach. The

interventions suggested are cost effective, straightforward and scalable.

Limitations

The survey was anonymous. It would have been useful to collect contact information from GPs who

would like to be involved in further work on this project. As this was a survey, bias in respondents

is a possibility.

Suggestions for future research

Further work is required to establish how to implement and roll out these interventions. Particular

attention should be directed towards reaching and engaging a maximum audience.

How to Cite: Fagan N, Dvorakova V, McAleer M, Browne F, Irvine AD, Carroll Á. Integrating care in Irish paediatric dermatology services: an analysis of GP experiences. International Journal of Integrated Care. 2022;22(S1):60. DOI: http://doi.org/10.5334/ijic.ICIC21034
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Published on 08 Apr 2022.

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