An audit of a new rapid access clinic for older people has found that some four in 10 people assessed in the Dublin facility would have required hospital admission had the quick assessment clinic not been available to them, writes Dr Muiris Houston, Medical Correspondent.
The St Mary's Rapid Access Clinic, a public/private collaboration between St Mary's Hospital, Phoenix Park and the Charter Medical Group in Smithfield, Dublin, was set up in 2006 to assess and diagnose patients over 65 outside the acute hospital system.
Around 3,000 people have been assessed and examined at the facility at Smithfield to date; the majority of these have been referred by GPs in the greater Dublin area.
According to Dr Dermot Power, consultant geriatrician at St Mary's and the Mater Hospital, and medical director of the new clinic, it is designed to fast-track the care of older patients who develop urgent symptoms that do not require emergency treatment.
"Initial analysis would suggest that as many as 42 per cent of patients being assessed under the rapid access clinic would have been admitted to hospital, hence the scheme is potentially relieving pressure on the public hospital system," Dr Power said.
GPs are encouraged to refer people who have had recent falls, unexplained weight loss, mini-strokes or blackouts.
Using the diagnostic facilities at the Charter Medical Centre, a patient can have blood tests, heart tests, X-rays and ultrasound on the day of assessment. More complex tests, such as MRI or CT scans, are available within 48 hours of referral.
The service cost the Health Service Executive (HSE) €1.6 million in 2007 and is projected, in line with increased demand, to require funding of €2.5 million this year. The HSE has seconded Dr Power from St Mary's for a number of sessions per week. Charter Medical pays for two consultant geriatricians to staff the rapid access clinic and also employs specialist nursing staff.
All medical care in the new clinic is funded by the HSE and is free to patients, with transport to and from the clinic also provided.
The rapid access clinic concept started in 2003 at St Mary's Hospital without the involvement of the private sector.
However, doctors found it difficult to access diagnostic tests through the public hospital system and were given a small budget by the HSE to source tests in the private sector.
I2006, the HSE and Charter Medical entered into a formal arrangement to relocate the clinic to the Smithfield facility.
Asked by The Irish Times if the new clinic was merely a method to quickly access diagnostic tests for older patients, Dr Power disagreed: "The new clinic is not an isolated facility; it remains integrated within the broader health system."
An analysis of the ultimate destination of 1,400 patients assessed in the clinic has found that 65 per cent had been managed entirely within the clinic before being referred back to their GP.
Some 10 per cent of older people were admitted to St Mary's Hospital, with a further 20 per cent referred to specialist clinics at the Mater Hospital.
Immediate referral to the emergency department of the Mater Hospital was required in 5 per cent of cases.
Some 31 per cent of people seen at the clinic had undiagnosed cardiovascular disease, while 13 per cent were found to have cancer.