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Accessing lymphoedema services in Fife.

By Catherine Bulley


Introduction: Lymphoedema is a chronic condition that deteriorates without management and leads to reduced function and quality of life1. Management requires a specialist service; in Fife, this is provided in the acute hospital setting. Concerns regarding the adequacy of this service led to an investigation of the needs of individuals with lymphoedema2. This included an exploration of service accessibility.\ud Method: Data were obtained from two groups: \ud 1) lymphoedema service referrers: a sample of 50 general practitioners was sought from primary practices throughout Fife, with a final response of 44. Short, targeted telephone surveys explored awareness of lymphoedema and referral practices.\ud 2) lymphoedema service providers: qualitative interviews with providers from three services explored experiences in relation to the ease of access to services for clients. \ud No ethical approval was required. Survey data was analysed descriptively and interview transcripts were themed within a post-positivist conceptual framework.\ud Results: Triangulation of the findings indicated: \ud 1) poor likelihood of referral: not all referrers have sufficient awareness of lymphoedema, or give it enough credibility, to seek investigation and diagnosis for their clients: 30% described delaying referral for investigations or management. A lack of awareness was demonstrated in relation to management options and only 7% of those interviewed would refer to specialist services. These findings were supported in comments from service providers.\ud 2) limited geographical access to services: the referrers who referred directly to specialist services were in closer proximity to those services, potentially impacting on their awareness. Providers indicated that owing to the distances involved, many clients relied on private transportation to allow their attendance. \ud Conclusions: Access to lymphoedema services in Fife is limited by a lack of awareness among referrers, and by the centralisation of services. Different models of service delivery should be evaluated, and methods of promoting the service should be explored

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