All hubs and no spokes – equity of access for dermatology patients

The Irish Skin Foundation (ISF) has called for research into the effects that a household’s distance from specialist dermatology services is having on patients living with chronic inflammatory skin disorders, such as psoriasis, atopic eczema and hidradenitis suppurativa (HS).

David McMahon, CEO, Irish Skin Foundation said, “We know anecdotally from the ISF Helpline that disadvantaged, less-abled, and marginalised patients, who don’t live near urban centres with public transport, don’t or can’t travel to access specialist services clustered in Ireland’s major hospitals.

“This means that the most vulnerable and less well-off patients have difficulty accessing services where they are needed, leading to more suffering, poorer health outcomes and greater severity of disease”.

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The ISF says that access and utilisation of health services is multi-faceted, but is often influenced by cultural, behavioural and financial factors. One critical variable is thought to be the distance of the patient’s household from a specialist clinic. The phenomenon of decreasing health care utilisation with increasing distance lived from a facility is often called the “distance-decay effect”.

“It appears that the current model for delivering services is weighted too far in favour of hubs based in major cities. It is failing to deliver equity in access for thousands of children and adults living with skin conditions in many parts of Ireland – notably in the Midlands, North West and South East.

“We don’t understand the full impact of the distance-decay phenomenon on people living with chronic skin disorders. Policy research is urgently needed to feed into an evidence-based service planning process, so that care is delivered in a manner that guarantees better access for all people living with a chronic skin disease,” said Mr. McMahon.

The ISF said outreach clinics in peripheral hospitals – as part of a hub-and-spoke model – currently deliver services for the following centres:

  • Tralee, Bantry, Clonmel and Mallow for Ireland South.
  • Nenagh, Ennis for the University of Limerick network.
  • Ballinasloe, Castlebar, Roscommon, Letterkenny for the Saolta network.
  • Cavan and Connolly for Dublin North East.
  • Naas and (in the coming months) Portlaoise for the Dublin Mid-Leinster network,
  • Commitment to Mullingar in upcoming new posts for the Ireland East network.
  • Proposed services in Kilkenny and Tullamore have not yet been developed.

“Outreach clinics each operate from a hub hospital, seeing up to 20 new patients or 30 returning patients each day. Some services operate one or two clinics each week, others less frequently; nationwide such clinics can potentially care for between 250-450 patients each week depending on a number of variables. Research into service planning is needed to determine whether or not patients’ long-term health outcomes can be optimised by delivering more services along this model,” said Mr. McMahon.