BMJ 1995;311:326 (29 July)

Letters

Open access to specialist opinion is preferable

EDITOR,--C M Francis and colleagues' report on open access echocardiography1 highlights the fears of many cardiologists about open access services.2 The principal aim of the authors' service--the identification of patients with left ventricular dysfunction so that treatment with an angiotensin converting enzyme inhibitor could be started--occurred in only 50 (19%) of 259 patients, while valve disease was identified in 12. In a similar study of an open access exercise electrocardiography service McClements et al identified ischaemic heart disease in only 18% of the 192 patients tested.3 It is argued that a negative result of the test is reassuring, but many patients remain symptomatic despite reassurance.4 Furthermore, screening a low risk population will result in a much higher proportion of false negative results. It remains to be seen whether open access to investigations represents an effective use of expensive and scarce resources. Hampton and Barlow argue that specialists are most useful . . . [Full text of this article]


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Relevant Article

Open access echocardiography in management of heart failure in the community
C M Francis, L Caruana, P Kearney, M Love, G R Sutherland, I R Starkey, T R D Shaw, and J J V McMurray
BMJ 1995 310: 634-636. [Abstract] [Full Text]

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