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Multi-disciplinary centres/networks
of excellence for endometriosis management and research
Centres/networks
of excellence could improve cost effectiveness of the
management of endometriosis, through a reduction in
the time to diagnosis, early specialist care, and less
hit and miss treatments for women with
endometriosis.
In this opinion paper the authors argue
that centres/networks of excellence are the only way
forward to ensure that women with endometriosis receive
consistent, evidence based care. Within the context
of either a centre - or a network - of excellence, continuity
of multi-disciplinary care would ensure that patient
outcome is the central focus. Furthermore, such a set-up
would also allow for improved scientific research because
it would make it possible to create the critical mass
of patients and tissue samples that are needed in order
to make progress.
Centres/networks of excellence should
be accredited as training centres by professional bodies,
and would only achieve such accreditation through adherence
to specialist (and ongoing) training, evidence-based
guidelines, quality management, and continuous measurement
of patient outcomes.
Each patient should be assigned a primary
gynaecologist to see them through their individual long-term
multi-diciplinary treatment plan. This primary gynaecologist
will need to work together with a therapeutic network,
committed to the above mentioned accreditation, which
may consist of:
- gynaecologists with a sub-speciality certificate
in reproductive endocrinology and infertility;
- a multi-disciplinary surgical team led by a surgically
experienced gynaecologist working together for complex
cases with urologists, gastrointestinal surgeons and/or
general surgeons;
- pain specialists;
- nurses;
- physiotherapists;
- counsellors;
- psychologists/psychiatrists;
- nutritionists/dieticians;
- patient support organisations;
- non-traditional practitioners.
According to the authors, these practitioners,
with their different set of skills, may all play an
important role in providing a holistic solution to an
individual's needs. If all these cogs in this treatment
and management wheel are well linked, the likelihood
of positive, long-term results become greater.
Early referral to a centre of expertise,
which is skilled in the recognition and diagnosis of
endometriosis, may therefore have a profound impact
on the reduction of health care, and individual, costs
by:
- reducing time to diagnosis and the time wasted to
see numerous health care professionals;
- subsequently reducing time to individualised specialist
care;
- subsequently reducing hit and miss treatments;
- subsequently reducing fertility treatments if the
disesae is under control before fertility is affected.
and, ultimately, improving overall quality of life
for the woman with endometriosis.
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