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.
