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Specialist availability was provided on site for 12 hours but was also available after hours if needed.
Moreover, factors other than specialist availability may influence the need for hospitalization in IBD patients.
In regional and urban areas specialist availability was also a challenge.
Level 3 Trauma Centres are characterised by having less than full specialist availability, but full resources for resuscitation, and ICU.
This is in line with studies suggesting that the awareness of specialist availability by PCPs affects their referral decisions.
Identifying "trans-friendly" colleagues for referral outside of one's scope of practice was difficult, both for lack of knowledge regarding specialist availability, and for concern regarding colleagues' sensitivity.
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Among secondary care specialists, availability of training was reported by 84%% (although only by 44%% in Italy), among GPs by two thirds (although only by half of them in Germany and Spain and by 40%% in the UK) and by 55%% among SHS experts.
Professional and/or practical support by colleagues, local specialist services, availability of a specialist consultant or consultation team, as well as 24/7 on-call service, preferably by a local (children's) inpatient service were wanted.
While outside the scope of this paper, it would be reasonable for countries to ensure optimal training (and specialist) job availability to capture those newly graduating doctors interested in psychiatry.
One possible solution for the inconsistency of specialist doctor availability for antenatal care is to train midwives adequately to care for low risk women and refer women with risk factors to a reliable tertiary service however this necessitates a reliable ambulance service for transfers and the availability of a SBA for escort.
The system of follow up is traditionally service-driven by regular hospital reviews initiated by the rheumatologist or nurse specialist, or the availability of appointments in a schedule.
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