Improving patient services by alternative prescribing: experience with radioiodine treatment

Improvements in health service provision need not be costly and indeed may save money. Administration of radio iodine ((131)I) to patients with thyrotoxicosis in the UK is often delayed because few endocrinologists have appropriate Administration of Radioactive Substances Advisory Committee (ARSAC) certification. Hence referral must be made to an oncologist. We tried to reduce the time to treatment by acquiring an appropriate licence for an endocrinologist and hence eliminating need for further referral.

An observational study of 414 doses of (131)I administered to 353 patients for benign thyroid disorders at a district general hospital by either endocrinologist or oncologist. After decision to treat had been made, the time taken for treatment to be given was compared between the groups.

An endocrinologist licensed to prescribe (131)I reduced the time taken from referral to administration of (131)I from 28 to 12 days (P<0.001) compared with oncologists. A further group seen by another endocrinologist and then referred to the licensed endocrinologist also had their delay reduced to 19 days. Treatment was administered within three weeks in 88% of treatments by the endocrinologist, 62% by the non-licensed endocrinologist and only 28% by oncologists.

Improving treatment times for patients were achieved at no extra cost and indeed freed up time for oncologists. Encouraging alternative means of delivering services can result in not only better services but also in cost savings. As certification is simple, endocrinologists should be encouraged to deliver (131)I themselves rather than devolving care to other practitioners.