Abstract
Background: The Integrated Model of Care (MoC) for the prevention and management of chronic disease is being implemented across Irish Health Services since 2021 and aims to provide universal access to a range of spectrum of chronic disease services from prevention, diagnostics, treatment and access to self management support. These Integrated services are delivered across General Practice, new Chronic disease community specialist teams (CD CSTs) and acute hospitals. This paper focuses on a new model of providing access to diagnostics for respiratory (spirometry and Pulmonary function tests) and cardiology (NTproBNP and echocardiography) conditions which is integrated with other services and provides universal access for all and enables timely access to treatment services if required.
Approach: Heretofore, access to NTproBNP, Echocardiography and Spirometry was only available through referral to acute hospital Consultants which resulted in lengthy delays in providing the diagnostic test, subsequent treatment and poorer outcomes for patients. A model to provide General Practitioners with direct referral access to support early diagnosis and treatment was developed and implemented. Using a population planning approach and collaboration with local acute laboratories (NTproBNP) and cardiology and respiratory physiology departments the potential demand was determined for the above diagnostics tests.
Results: An additional 28 Laboratory science staff across 20 laboratories in Ireland have been funded and the services is now operational to provide direct GP Access to NTproBNP. A recent audit via chart review by 10 general practitioners of NT-proBNP tests ordered in their respective clinics was conducted during the first six months of 2024. Audit returns on 192 NT-proBNP tests for patients aged 65 years plus were received.
- Less than 20% of NT-proBNP results led to referral to hospital services
- More than 80% of test results were managed in GP.
- 36 (19%) patients were referred to secondary care, which suggests that GPs (appropriately) are managing a majority of patients with abnormal NT-proBNP results within general practice.
- The findings of this national audit suggest that 82% of tests are being ordered within guidelines.
- NT-proBNP availability has reduced referrals to diagnostic/outpatient/Community CD CST services for these patients by 51% and reduced ED/AMAU referrals for these patients by 76%
An additional 80 (42 cardiac and 38 respiratory physiologists) were funded across hospital departments and provided. Significant clearance of long waiters from existing waiting lists and a reduction in wait times and in the number for echocardiography and spirometry have been observed across a number of sites where the Direct GP access service is operational.
Implications: This is a new model providing universal access and way of working which has potential to have significant impact on reduction on hospital waiting lists, supporting hospital avoidance through early diagnosis and treatment and facilitating more timely access to integrated care services for patients.