Nigeria like many low and middle income countries has inadequate specialist mental health personnel, with less than one psychiatrist to one million population and with the few available specialists inequitably concentrated in urban settings [ 9].
More negative beliefs towards drug effectiveness were found in those who had received inadequate specialist support to find optimum treatment (" I need to know the reasons why I'm taking it [medication] and what effects I can expect because otherwise the negative sides of things outweigh it" P10).
Case note audit of young adults with type 1 diabetes accessing diabetes services in the state capital, a city and regional areas of New South Wales (NSW) in Australia demonstrated inadequate routine specialist care, poor self-management and frequent use of acute services for crisis management, particularly in regional areas [ 4]; however, sample sizes were small.
Regarding rheumatoid arthritis (RA), an inadequate access to specialists leads to diagnosis and treatment delays diminishing the probability of remission or control.
Factors adding to the strain on the mental health system include a shortage of mental health staff and specialists, inadequate collaboration between current mental health institutions, and insufficient funding [ 14].
Specifically, lack of reimbursement mechanisms for specialists, inadequate funding for on-going costs to support the technology platform, and a dearth of administrative support to maintain the system were mentioned by many study participants (Table 2).
The increase in time between diagnosis and treatment after implementation of the Cancer Plan could reflect an increased burden to secondary care, resulting from the rising colorectal cancer incidence and an inadequate number of specialists and facilities to cope with growing demand [ 33].
However, Bird et al. [ 5] suggested further training of GPs was required because of inadequate referral for specialist consultation.
Some informants were satisfied, while others cited that inadequate communication between specialist and PCP could lead to provision of contradictory information by healthcare professionals, causing patient confusion.
Group B consisted of 66 patients whose BP response to clinic-prescribed antihypertensive treatment was considered inadequate by a specialist in hypertension.
