In turn, this led to poor specialist satisfaction.> By contrast, the main driver of implementing electronic consultation or integrated eCR systems was poor access to specialty care, particularly evidenced by long patient wait times for in-person specialty appointments.
This is because venous access can be poor and specialist staff (who may not be available at all potential testing sites) are required to take blood, which if only available in hospital phlebotomy services can increase stigma.
The NHS Cancer Plan has recognised this inequality and has proposed methods of reducing these inequalities by improving access for the poor to specialist services and more importantly providing a comprehensive programme of guidance setting national standards.
The facilities available lie between the extremes seen in developed countries and those in poorer (non-specialist) centres in sub-Saharan Africa.
Several studies in wealthy countries suggest that utilization of GP and hospital services, after adjusting for health care need, is equitable or pro-poor, whereas specialist care tends to favour the better off.
A number of subjects noticed there was poor communication among specialists.
(H1 DP15, Interview 1)" The reason for poor relations between specialists and nurses seemed partly due to hostile power dynamics, particularly when fatigue sets in and tempers become frayed, as explained by one respondent.
Among many possible factors, a lack of co-management between primary care and arthritis specialists, poor between-provider communication about who should be responsible for providing preventive services and tests, and time pressures on office visits to manage complex patients, may result in patients failing to receive recommended care.
These studies demonstrated that HCP report multiple barriers to caring for persons with diabetes such as inadequate funding, limited time to spend with patients, poor access to specialists, ineffective patient and HCP education on diabetes care, and lack of patient motivation to make lifestyle changes.
However, a number of patients may have poor control despite specialist care, and this along with devolution of care to non-specialists suggests that alternative interventions should be developed.
