What is the effectiveness of community diagnostic centres: a rapid review (preprint)

The COVID-19 pandemic directly impacted diagnostic services in the UK and globally. This exacerbated the rapid rise in demand for diagnostics that existed before the pandemic, resulting in significant numbers of patients requiring various diagnostic services and increased waiting times for diagnostics and treatment. In 2021, community diagnostic centres were launched in England. As diagnostic services account for over 85% of clinical pathways within the NHS and cost over six billion pounds per year, diagnostic centres across a broader range of diagnostic services may be effective, efficient, and cost-effective in the UK health sector. This rapid review aimed to identify and examine the evidence on the effectiveness of community diagnostic centres. A prior Research Evidence Map was used, along with the stakeholder input, to select a substantive focus for the rapid review. Comparative studies examining community diagnostic centres that accept referrals from primary care as a minimum were included. Prioritised outcomes included those relating to impact on capacity and pressure on secondary care, ensuring equity in uptake or access, and economic outcomes The review included evidence available up until August 2022. Twenty primary studies were included. Twelve individual diagnostic centres were evaluated across the 20 studies. Most studies evaluated diagnostic centres located within hospital settings. One study evaluated a mobile diagnostic ultrasound service. Most studies were specific to cancer diagnoses. Six studies covered multiple health conditions, which will have also included cancer. Other conditions reported included: severe anaemia, fever of uncertain nature, and multiple sclerosis. A range of outcomes was identified. 11 studies conducted in Spain evaluated the same type of clinic i.e. Quick Diagnostic Unit and seven studies evaluated the same centre at different time intervals. No evidence relating to equity of access was identified. The evidence relating to effectiveness appeared mixed. There is evidence to suggest that diagnostic centres can reduce various waiting times, including time to surgical consultation, time from consultation to treatment, time from cancer suspicion to treatment, time from diagnosis to specialist consultation and time from diagnosis to treatment. Diagnostic centres could help reduce pressure on secondary care by avoiding hospitalisations in stable patients. Cost-effectiveness may depend on whether the diagnostic centre is running at full capacity. Factors that could determine the costs incurred by a centre include the diagnostic and clinical complexity of patients, and the characteristics of the unit including the number of staff and contribution of staff time.

A rapid evidence map of what evidence is available on the effectiveness of community diagnostic centres (preprint)

The COVID-19 pandemic has resulted in increased demand and delays to diagnostic services. Community diagnostic centres (which are generally referred to as Regional Diagnostic Hubs in Wales) aim to reduce this backlog and the waiting times for patients by providing a broad range of elective diagnostic services in the community, away from acute hospital facilities. As diagnostic services account for over 85% of clinical pathways and cost the National Health Service (NHS) over six billion pounds a year (NHS 2022), community diagnostic centres across a broader range of diagnostic services may be an effective, efficient, and cost-effective introduction to the UK health sector. This Rapid Evidence Map aimed to identify, describe, and map the available evidence on the effectiveness of diagnostic centres. 50 primary studies were identified. Studies were published between 1995 and 2021: A wide range of study designs were used, and studies were conducted in a range of countries including the UK. 30 studies were specific to cancer diagnosis, whilst the remaining 20 studies focused on diagnosis associated with: anaemia, autism, cerebral palsy, intellectual disability, multiple sclerosis, respiratory conditions, shoulder pain, and unexplained fever Eleven studies reported information on multi-condition diagnostic centres, rather than a specific condition. The majority of studies were conducted within hospital settings. Two studies evaluated diagnostic centres within a community setting. The diagnostic centres offered a wide range of diagnostic tests and incorporated different staff and facilities. Participants were mainly referred by GPs, primary care centres and emergency departments. However, referrals were also made from outpatient clinics located within the same hospital as the diagnostic centre. Over 100 different outcomes were reported covering: patient data and referral outcomes, clinical outcomes, performance outcomes, economic outcomes, and patient and physician-reported outcomes. The findings of this rapid evidence map were used to select a substantive focus for a subsequent rapid review on community diagnostic centres that can be accessed by primary care teams.

A rapid review of barriers and facilitators to cancer screening uptake (breast, cervical and bowel) in underserved populations (preprint)

In the United Kingdom (UK), the National Health Service (NHS) provides population-based screening programmes for breast, bowel, and cervical cancer. These programmes were temporarily paused in March 2020, due to the COVID-19 pandemic, resulting in large numbers of the eligible population having their invitations delayed. This disruption may have had a disproportionate impact on underserved populations for whom there was a lower uptake prior to the pandemic. Some people may also be less willing to attend screening after the pandemic. Interventions and campaigns designed to encourage people to take part in cancer screening may need to be adapted after the pandemic, in particular those targeting underserved populations. This rapid review aimed to identify the barriers and facilitators to breast, bowel, and cervical screening uptake in underserved populations (e.g. clinically vulnerable, shielding, multi-morbidities, ethnic minorities, social deprivation, gender, age) during and since the onset of the pandemic, using evidence from the UK and other countries with similar cancer screening programmes (such as Australia and Netherlands), and to compare with the pre-pandemic literature. The pre-pandemic literature was identified using a supplementary scoping search for published systematic reviews. Three primary studies (two published and one ongoing trial) conducted during the pandemic were identified. Five systematic reviews of pre-pandemic evidence were also included. Two qualitative studies conducted during the pandemic were appraised as high quality but both included sample populations with limited representation. No primary studies specifically exploring the impact of the pandemic on barriers and facilitators to screening uptake among underserved groups were identified. The findings did not show marked differences in the barriers and facilitators for screening uptake before and during the COVID-19 pandemic in underserved populations. However, it is unclear whether this is because these genuinely remain unchanged or reflects the lack of available evidence. The findings may only be transferable to the population groups studied.