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1.
Peter Hjertholm Grete Moth Mads Lind Ingeman Peter Vedsted 《The British journal of general practice》2014,64(623):e346-e353
Background
Knowledge is sparse on the prevalence of suspicion of cancer and other serious diseases in general practice. Likewise, little is known about the possible implications of this suspicion on future healthcare use and diagnoses.Aim
To study the prevalence of GPs’ suspicions of cancer or other serious diseases and analyse how this suspicion predicted the patients’ healthcare use and diagnoses of serious disease.Design and setting
Prospective population-based cohort study of 4518 patients consulting 404 GPs in a mix of urban, semi-urban and rural practices in Central Denmark Region during 2008–2009.Method
The GPs registered consultations in 1 work day, including information on their suspicion of the presence of cancer or another serious disease. The patients were followed up for use of healthcare services and new diagnoses through the use of national registers.Results
Prevalence of suspicion was 5.7%. Suspicion was associated with an increase in referrals (prevalence ratio [PR] = 2.56, 95% confidence interval [CI] = 2.22 to 2.96), especially for diagnostic imaging (PR = 3.95, 95% CI = 2.80 to 5.57), increased risk of a new diagnosis of cancer or another serious disease within 2 months (hazard ratio [HR] = 2.98, 95% CI = 1.93 to 4.62) — especially for cancer (HR = 7.55, 95% CI = 2.66 to 21.39) — and increased use of general practice (relative risk [RR] = 1.14, 95% CI = 1.06 to 1.24) and hospital visits (RR = 1.90, 95% CI = 1.62 to 2.23). The positive predictive value of a GP suspicion was 9.8% (95% CI = 6.4 to 14.1) for cancer or another serious disease within 2 months.Conclusion
A GP suspicion of serious disease warrants further investigation, and the organisation of the healthcare system should ensure direct access from the primary sector to specialised tests. 相似文献2.
Corlien JH de Vries Margreet Wieringa-de Waard Patrick JE Bindels Willem M Ankum 《The British journal of general practice》2011,61(587):e340-e346
Background
Diagnostic ultrasonography is used by GPs in approximately 10% of patients of reproductive age with abnormal vaginal bleeding. Transvaginal sonography is recommended as a first-line diagnostic instrument for assessing uterine pathology.Aim
To assess if findings resulting from openaccess sonography were in agreement with the GPs’ working hypotheses and if these findings contributed to GPs’ management.Design and setting
Prospective observational cohort study of GPs working in the health district of the Academic Medical Center, Amsterdam and their patients consulting with abnormal vaginal bleeding.Method
Data on patients’ history, GPs’ primary working hypotheses, and intended management were recorded. After sonography, GPs recorded their actual management.Results
A total of 122 patients were included by 18 GPs from June 2003 to December 2004. Data from 89 patients were available for analysis. The GPs’ working hypotheses implied ‘no structural pathology’ in 65/89 patients, and ‘fibroids’ in 24/89 patients. Sonographic findings were confirmed in 50/65 patients where ‘no structural pathology’, and in 14/24 of those where ‘fibroids’ were expected. Initially, GPs had intended to refer nine patients to a gynaecologist. Actual management after sonographic assessment was watchful waiting or drug therapy in 57/89 patients. Eighty-nine per cent of these patients had normal sonographic findings. The actual referral rate rose to 27/89 patients. In 17 referred patients, sonographic findings were suggestive of intracavitary abnormalities.Conclusion
Open-access sonography contributed to more accurate diagnoses and improved GPs’ management of women with abnormal vaginal bleeding. 相似文献3.
Mette B Larsen Rikke P Hansen Frede Olesen Peter Vedsted 《The British journal of general practice》2011,61(586):e215-e222
Background
General practice plays an important role in the cancer care pathway. The initial diagnostic phase may be crucial for the relationship between the patient and the GP.Aim
The aim was to describe whether patients'' confidence in their GP changed after a cancer diagnosis, and analyse whether the change in confidence was associated with doctor delay.Design and setting
Population-based cohort study with 1892 questionnaires sent to patients and their GPs in general practices in the former Aarhus County, Denmark.Method
Information on patients'' confidence in their GP was obtained from the patient questionnaire. Information on doctor delay was obtained from the GPs and defined as a period of 14 days or more from the date of first symptom presentation to the GP until cancer-specific investigation was initiated.Results
Before the cancer diagnosis, 88.4% of the patients had confidence in their GP, which decreased to 80.0% after the diagnosis (P<0.001); 15.8% of the patients who experienced no doctor delay reported a decrease in confidence after the cancer diagnosis, compared with 29.1% of the patients with a doctor delay (P<0.001). Patients presenting with alarm symptoms and experiencing doctor delay were 3.8 times more likely to lose confidence compared with those presenting with alarm symptoms who experienced no doctor delay (P = 0.048).Conclusion
The majority of the patients had high levels of confidence in their GP before, as well as after, the cancer diagnosis. Nevertheless, a substantial amount had low confidence in the GP, especially when experiencing doctor delay in the initial phase of the pathway. 相似文献4.
Sanjiv Ahluwalia Elizabeth Murray Fiona Stevenson Cicely Kerr Jo Burns 《The British journal of general practice》2010,60(571):88-94
Background
Government policy is to encourage self-help among patients. The internet is increasingly being used for health information. The literature on the role of the internet in the doctor–patient consultation remains sparse.Aim
To determine the perceived responses of GPs to internet-informed patients in consultations and the strategies GPs use for dealing with information from the internet being brought into consultations.Design of study
A qualitative study design was used, with semi-structured interviews.Setting
GPs based in North Central London.Method
Analysis was conducted by a multidisciplinary team of researchers. Participants were 11 GPs: five partners, three locums, and three salaried doctors; seven were white, three were Asian, and one was of Chinese origin. The median year of General Medical Council (GMC) registration was 1989. There were six women and five men; five participants worked in training practices.Results
GPs experienced considerable anxiety in response to patients bringing information from the internet to a consultation but were able to resolve this anxiety. The study participants learned to distance themselves from their emotional response, and used cognitive and behavioural techniques to assist them in responding appropriately to patients. These techniques included buying time in a consultation, learning from previous consultations, and using the internet as an ally, by directing patients to particular websites. The importance for doctors of feeling valued by patients was apparent, as was the effect of the prior doctor–patient relationship.Conclusion
GPs interviewed used sophisticated mechanisms for dealing with their emotions. GPs struggling with internet-informed patients can use the mechanisms described to alleviate the difficulties. 相似文献5.
Andor E Simon Sabrina Jegerlehner Thomas M��ller Katja Cattapan-Ludewig Peter Frey Marcus Grossenbacher Erich Seifritz Daniel Umbricht 《The British journal of general practice》2010,60(578):e353-e359
Background
GPs are often the first point of contact for patients with prodromal schizophrenia. Early intervention, and therefore early detection, of schizophrenia is pivotal for the further disease course. However, recent studies have revealed that, due to its low prevalence in general practice and its insidious features, prodromal schizophrenia often remains unnoticed.Aim
To test whether a repeated sensitisation method using clinical vignettes can improve diagnostic knowledge of GPs.Design of study
Postal survey using anonymous questionnaires.Repeated sensitisation model using clinical vignettes.Setting
GPs in three distinct regions in Switzerland covering a general population of 1.43 million.Method
The study was conducted between September 2008 and October 2009. Questionnaires were sent to 1138 GPs at baseline, and at 6 and 12?months. After randomisation, 591 GPs were sensitised at 1, 3, and 5?months, while no sensitisation was carried out in the remaining 547 GPs.Results
The overall response rate was 66% (750 GPs).Sensitised GPs demonstrated a highly significant increase in diagnostic knowledge at 6 and at 12?months when compared to their own baseline knowledge scores and also to non-sensitised GPs (P<0.001). In particular, awareness of insidious features, such as functional decline and social withdrawal as signs of prodromal schizophrenia, accounted for this effect.Conclusion
Theoretical knowledge of prodromal schizophrenia among GPs can successfully be increased by repeated sensitisation models using clinical vignettes. 相似文献6.
Shamail Ahmad Martin Orrell Steve Iliffe Antonia Gracie 《The British journal of general practice》2010,60(578):e360-e365
Background
In primary care, the diagnosis of dementia is often delayed and the 2007 National Audit Office Report concluded action was needed to improve patient care and value for money.Aim
To investigate the attitudes, awareness, and practice of GPs in England regarding early diagnosis and management of patients with dementia, and perceptions of local specialist services, to identify training or support needs.Design of study
Secondary analysis of survey data that capture the above attitudes, awareness, and practice.Setting
Online survey, targeting GP members of medeConnect.Method
Survey data were obtained using an anonymised online self-completion questionnaire, and then analysed using standard data-analysis software.Results
A total of 1011 GPs across the eight English regions responded. Older GPs were more confident in diagnosing and giving advice about dementia, but less likely to feel that early diagnosis was beneficial, and more likely to feel that patients with dementia can be a drain on resources with little positive outcome. Younger GPs were more positive and felt that much could be done to improve quality of life. Attitudes had no correlation with sex. GPs in general felt they had not had sufficient basic and post-qualifying training in dementia, and overall knowledge about dementia was low.Conclusion
Much could be done to improve GPs'' knowledge of dementia, and the confidence of older GPs could be an educational resource. However, greater experience may create scepticism about early diagnosis because of the perceived poor quality of specialist services. 相似文献7.
Bregje Thoonsen Yvonne Engels Eric van Rijswijk Stans Verhagen Chris van Weel Marieke Groot Kris Vissers 《The British journal of general practice》2012,62(602):e625-e631
Background
According to the World Health Organization (WHO) definition, palliative care should be initiated in an early phase and not be restricted to terminal care. In the literature, no validated tools predicting the optimal timing for initiating palliative care have been determined.Aim
The aim of this study was to systematically develop a tool for GPs with which they can identify patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer respectively, who could benefit from proactive palliative care.Design
A three-step procedure, including a literature review, focus group interviews with input from the multidisciplinary field of palliative healthcare professionals, and a modified Rand Delphi process with GPs.Method
The three-step procedure was used to develop sets of indicators for the early identification of CHF, COPD, and cancer patients who could benefit from palliative care.Results
Three comprehensive sets of indicators were developed to support GPs in identifying patients with CHF, COPD, and cancer in need of palliative care. For CHF, seven indicators were found: for example, frequent hospital admissions. For COPD, six indicators were found: such as, Karnofsky score ≤50%. For cancer, eight indicators were found: for example, worse prognosis of the primary tumour.Conclusion
The RADboud indicators for PAlliative Care Needs (RADPAC) is the first tool developed from a combination of scientific evidence and practice experience that can help GPs in the identification of patients with CHF, COPD, or cancer, in need of palliative care. Applying the RADPAC facilitates the start of proactive palliative care and aims to improve the quality of palliative care in general practice. 相似文献8.
Chris Salisbury Sunita Procter Kate Stewart Leah Bowen Sarah Purdy Matthew Ridd Jose Valderas Tom Blakeman David Reeves 《The British journal of general practice》2013,63(616):e751-e759
Background
Demographic and policy changes appear to be increasing the complexity of consultations in general practice.Aim
To describe the number and types of problems discussed in general practice consultations, differences between problems raised by patients or doctors, and between problems discussed and recorded in medical records.Design and setting
Cross-sectional study based on video recordings of consultations in 22 general practices in Bristol and North Somerset.Method
Consultations were examined between 30 representative GPs and adults making a pre-booked day-time appointment. The main outcome measures were number and types of problems and issues discussed; who raised each problem/issue; consultation duration; whether problems were recorded and coded.Results
Of 318 eligible patients, 229 (72.0%) participated. On average, 2.5 (95% CI = 2.3 to 2.6) problems were discussed in each consultation, with 41% of consultations involving at least three problems. Seventy-two per cent (165/229) of consultations included problems in multiple disease areas. Mean consultation duration was 11.9 minutes (95% CI = 11.2 to 12.6). Most problems discussed were raised by patients, but 43% (99/229) of consultations included problems raised by doctors. Consultation duration increased by 2 minutes per additional problem. Of 562 problems discussed, 81% (n = 455) were recorded in notes, but only 37% (n = 206) were Read Coded.Conclusion
Consultations in general practice are complex encounters, dealing with multiple problems across a wide range of disease areas in a short time. Additional problems are dealt with very briefly. GPs, like patients, bring an agenda to consultations. There is systematic bias in the types of problems coded in electronic medical records databases. 相似文献9.
Henry Jensen Aase Nissen Peter Vedsted 《The British journal of general practice》2014,64(619):e92-e98
Background
High quality in every phase of cancer diagnosis is important to optimise the prognosis for the patient. General practice plays an important role in this phase.Aim
The aim was to describe the prevalence and the types of quality deviations (QDs) that arise during the diagnostic pathway in general practice as assessed by GPs and to analyse the association between these QDs, the cancer type, and the GP’s interpretation of presenting symptoms as well as the influence on the diagnostic interval.Design and setting
A Danish retrospective cohort study based on questionnaire data from 1466 GPs on 5711 incident patients with cancer identified in the Danish National Patient Registry (response rate = 71.4%). The GP was involved in diagnosing in 4036 cases.Method
Predefined QDs were prompted with the possibility for free text. QD prevalence was estimated as was the association between QDs and diagnosis, the GP’s symptom interpretation, and time to diagnosis.Results
QDs were present for 30.4% (95% confidence interval [CI] = 29.0 to 31.9) of cancer patients. The most prevalent QD was ‘retrospectively, one or more of my clinical decisions were less optimal’. QDs were most prevalent among patients with vague symptoms (24.1% for alarm symptoms versus 39.5% for vague symptoms [P<0.001]). QD presence implied a 41-day (95% CI = 38.4 to 43.6) longer median diagnostic interval.Conclusion
GPs noted at least one QD, which often involved clinical decisions, for one-third of all cancer patients. QDs were more likely among patients with vague symptoms and increased the diagnostic interval considerably. 相似文献10.
Background
There is unequal access to health care in Australia, particularly for the one-third of the population living in remote and rural areas. Video consultations delivered via the Internet present an opportunity to provide medical services to those who are underserviced, but this is not currently routine practice in Australia. There are advantages and shortcomings to using video consultations for diagnosis, and general practitioners (GPs) have varying opinions regarding their efficacy.Objective
The aim of this Internet-based study was to explore the attitudes of Australian GPs toward video consultation by using a range of patient scenarios presenting different clinical problems.Methods
Overall, 102 GPs were invited to view 6 video vignettes featuring patients presenting with acute and chronic illnesses. For each vignette, they were asked to offer a differential diagnosis and to complete a survey based on the theory of planned behavior documenting their views on the value of a video consultation.Results
A total of 47 GPs participated in the study. The participants were younger than Australian GPs based on national data, and more likely to be working in a larger practice. Most participants (72%-100%) agreed on the differential diagnosis in all video scenarios. Approximately one-third of the study participants were positive about video consultations, one-third were ambivalent, and one-third were against them. In all, 91% opposed conducting a video consultation for the patient with symptoms of an acute myocardial infarction. Inability to examine the patient was most frequently cited as the reason for not conducting a video consultation. Australian GPs who were favorably inclined toward video consultations were more likely to work in larger practices, and were more established GPs, especially in rural areas. The survey results also suggest that the deployment of video technology will need to focus on follow-up consultations.Conclusions
Patients with minor self-limiting illnesses and those with medical emergencies are unlikely to be offered access to a GP by video. The process of establishing video consultations as routine practice will need to be endorsed by senior members of the profession and funding organizations. Video consultation techniques will also need to be taught in medical schools. 相似文献11.
12.
Cliodna AM McNulty Gemma Lasseter Neville Q Verlander Harry Yoxall Philippa Moore Sarah J O’Brien Mark Evans 《The British journal of general practice》2014,64(618):e24-e30
Background
The criteria used when GPs submit stool specimens for microbiological investigation are unknown.Aim
To determine what criteria GPs use to send stool specimens, and if they are consistent with national guidance, and whether GPs would prescribe an antibiotic before they receive a result.Design and setting
Questionnaire survey of 974 GPs in 172 surgeries in England.Method
GPs were sent a questionnaire (23 questions) based on national guidance.Results
Questionnaires were returned by 90% (154/172) of surgeries and 49% (477/968) of GPs. GPs reported sending stool specimens in about 50% of cases of suspected infectious diarrhoea, most commonly because of individual symptoms, rather than public health implications. Fewer considered sampling with antibiotic-associated diarrhoea post hospitalisation, or children with acute, painful, bloody diarrhoea; only 14% mentioned outbreaks as a reason. Nearly one-half of GPs reported they would consider antibiotics in suspected cases of Escherichia coli O157, which is contraindicated. Only 23% of GPs would send the recommended three specimens for ova, cysts, and parasites (OCP) examination. Although 89% of GPs gave some verbal advice on how to collect stool specimens, only 2% of GPs gave patients any written instructions.Conclusion
GPs need more education to address gaps in knowledge about the risks and diagnosis of different infections in suspected infectious diarrhoea, especially Clostridium difficile post-antibiotics, E. coli O157, and requesting OCPs. Advice on reports, tick boxes, or links to guidance on electronic request forms may facilitate this. 相似文献13.
Baker R Smith A Tarrant C McKinley RK Taub N 《The British journal of general practice》2011,61(591):e638-e644
Background
Revalidation is the UK process forthe review of doctors to ensure they are fit to practise. Revalidation will include patient feedback.Aim
To investigate the role of patient feedback on GPs'' consultations in revalidation.Design and setting
Cross-sectional survey of patients consulting 171 GPs.Method
A total of 6433 patients aged 16 years or over completed the consultation satisfaction questionnaire (CSQ). Generalisability analysis was undertaken, scale scores calculated, and outliers identified using two and three standard deviations from the mean as control limits. Comments made by patients were categorised into positive, neutral, or negative.Results
After averaging each scale for each doctor, mean scores (standard deviation), out of a possible score of 100, were: general satisfaction 78.1 (7.2); professional care 82.1 (6.1); relationship 71.2 (7.1); perceived time 65.7 (7.6). A D-study (which enables estimation of the reliability from 0-1 of the CSQ scores for different numbers of responders for each doctor), indicated that ratings by 19 patients would achieve a generalisability coefficient of 0.80 for the combined score. Fifteen GPs had one or more scale scores below two standard deviations of the mean. Comments were more often negative for GPs with scores below two standard deviations of the mean.Conclusion
Most patients of most GPs are satisfied with their experience of consultations, and ways to make patient feedback formative for these doctors is required. For a few GPs, most patients report some dissatisfaction. Patient feedback may identify doctors who need educational support and possibly remediation, but agreed questionnaire score thresholds are required, and agreement is needed on the weight to be attached to patient experience in comparison with other aspects of performance. 相似文献14.
Unni Ringberg Nils Fleten Olav Helge F?rde 《The British journal of general practice》2014,64(624):e426-e433
Background
There is a large variation in referral rates to secondary care among GPs, which is partly unexplained.Aim
To explore associations between reasons for referral to secondary care and patient, GP, and healthcare characteristics.Design and setting
A cross-sectional study in Northern Norway.Method
Data were derived from 44 (42%) of 104 randomly selected GPs between 2008 and 2010. GPs scored the relevance of nine predefined reasons for 595 referrals from 4350 consecutive consultations on a four-level categorical scale. Associations were examined by multivariable ordered and multivariable multilevel logistic regression analyses.Results
Medical necessity was assessed as a relevant reason in 93% of the referrals, 43.7% by patient preference, 27.5% to avoid overlooking anything, and 14.6% to reassure the patient. The higher the referral rates, the more frequently the GPs referred to avoid overlooking anything. Female GPs referred to reassure the patient and due to perceived deficient medical knowledge significantly more often than male GPs. However, perceived easy accessibility of specialists was significantly less frequently given as a reason for referral by female GPs compared with male GPs. When the GPs scored the referrals to be of lesser medical necessity, male GPs referred significantly more frequently than female GPs to reassure the patient due to patient preference and perceived deficient medical knowledge.Conclusion
There are striking differences in reasons for referral between Norwegian male and female GPs and between GPs with high and low referral rates, which reflects difficulties in handling professional uncertainty. Referring to reassure the patients, especially when referrals are less medically necessary, may reflect consideration and acquiescence towards the patients. 相似文献15.
Rachel M Dommett Theresa Redaniel Michael CG Stevens Richard M Martin William Hamilton 《The British journal of general practice》2013,63(606):e22-e29
Background
Guidelines describing symptoms in children that should alert GPs to consider cancer have been developed, but without any supporting primary-care research.Aim
To identify symptoms and signs in primary care that strongly increase the likelihood of childhood cancer, to assist GPs in selection of children for investigation.Design and setting
A population-based case-control study in UK general practice.Method
Using electronic primary care records from the UK General Practice Research Database, 1267 children aged 0–14 years diagnosed with childhood cancer were matched to 15 318 controls. Clinical features associated with subsequent diagnosis of cancer were identified using conditional logistic regression, and likelihood ratios and positive predictive values (PPVs) were estimated for each.Results
Twelve symptoms were associated with PPVs of ≥0.04%, which represents a greater than tenfold increase in prior probability. The six symptoms with the highest PPVs were pallor (odds ratio, OR = 84; PPV = 0.41% (95% confidence interval [CI] = 0.12% to 1.34%), head and neck masses (OR = 17; PPV = 0.30%; 95% CI = 0.10% to 0.84%), masses elsewhere (OR = 22; PPV = 0.11%; 95% CI = 0.06% to 0.20%), lymphadenopathy (OR = 10; PPV = 0.09%; 95% CI = 0.06% to 0.13%), symptoms/signs of abnormal movement (OR = 16; PPV = 0.08%; 95% CI = 0.04% to 0.14%), and bruising (OR = 12; PPV = 0·08%; 95% CI = 0.05% to 0.13%). When each of these 12 symptoms was combined singly with at least three consultations in a 3-month period, the probability of cancer was between 11 and 76 in 10 000.Conclusion
Twelve features of childhood cancers were identified, each of which increased the risk of cancer at least tenfold. These symptoms, particularly when combined with multiple consultations, warrant careful evaluation in general practice. 相似文献16.
Background
Camera phones have become ubiquitous in the digital age. Patients are beginning to bring images recorded on their mobile phones to share with their GP during medical consultations.Aim
To explore GP perceptions about the effect of patient-initiated camera phone images on the consultation.Design and setting
An interview study of GPs based in rural and urban locations in Australia.Methods
Semi-structured telephone interviews with nine GPs about their experiences with patient-initiated camera phone images.Results
GPs described how patient-initiated camera phone photos and videos contributed to the diagnostic process, management and continuity of care. These images gave GPs in the study additional insight into the patient’s world. Potential harm resulting from inappropriate use of camera phones by patients was also identified.Conclusion
Patient-initiated camera phone images can empower patients by illustrating their narratives, thus contributing to improved communication in general practice. Potential harm could result from inappropriate use of these images. GPs shown images on patients’ camera phones should make the most of this opportunity for improved understanding of the patient’s world. There are however, potential medicolegal implications such as informed consent, protection of patient and doctor privacy, and the risk of misdiagnosis. 相似文献17.
Claire Blacklock Tanya Ali Haj-Hassan Matthew J Thompson 《The British journal of general practice》2012,62(603):e679-e686
Background
NICE recommendations and evidence from ambulatory settings promotes the use of vital signs in identifying serious infections in children. This appears to differ from usual clinical practice where GPs report measuring vital signs infrequently.Aim
To identify frequency of vital sign documentation by GPs, in the assessment of children with acute infections in primary care.Design and setting
Observational study in 15 general practice surgeries in Oxfordshire and Somerset, UK.Method
A standardised proforma was used to extract consultation details including documentation of numerical vital signs, and words or phrases used by the GP in assessing vital signs, for 850 children aged 1 month to 16 years presenting with acute infection.Results
Of the children presenting with acute infections 31.6% had one or more numerical vital signs recorded (269, 31.6%), however GP recording rate improved if free text proxies were also considered: at least one vital sign was then recorded in over half (54.1%) of children. In those with recorded numerical values for vital signs, the most frequent was temperature (210, 24.7%), followed by heart rate (62, 7.3%), respiratory rate (58, 6.8%), and capillary refill time (36, 4.2%). Words or phrases for vital signs were documented infrequently (temperature 17.6%, respiratory rate 14.6%, capillary refill time 12.5%, and heart rate 0.5%), Text relating to global assessment was documented in 313/850 (36.8%) of consultations.Conclusion
GPs record vital signs using words and phrases as well as numerical methods, although overall documentation of vital signs is infrequent in children presenting with acute infections. 相似文献18.
William Hamilton Trish Green Tanimola Martins Kathy Elliott Greg Rubin Una Macleod 《The British journal of general practice》2013,63(606):e30-e36
Background
Diagnostic delay is deemed to account for an estimated 5000 to 10 000 extra cancer deaths each year in the UK. Many cancer patients do not have symptoms meeting national referral criteria for rapid investigation. Risk assessment tools (RATs) have been developed to assist GPs in selecting patient for cancer investigation.Aim
To assess the usability and acceptability of lung and colorectal RATs, as well as subsequent resource use and cancer diagnoses.Design and setting
Cohort study with nested qualitative study with 614 GPs from 165 practices in seven English cancer networks were provided with RATs applicable to patients aged ≥40 years with bowel or respiratory symptoms. In-depth interviews were conducted with 34 individuals (11 project managers and 23 GPs).Method
The study measured the number of RATs used, and subsequent cancer investigations and diagnoses, over a 6-month period and compared these with the previous 6 months.Results
A total of 2593 RATs (1160 lung, 1433 colorectal) were completed. Compared with the preceding 6 months, there were 292 more chest X-rays, 104 extra 2-week chest clinic appointments, and 47 additional diagnoses of lung cancer. For suspected colorectal cancer, there were 304 more 2-week referrals, 270 more colonoscopies, and 10 more cancers identified. RATs appeared to help GPs in their selection of patients for cancer investigation. Users reported that RATs helped to confirm a need for investigation as well as allowing reassurance when investigation was not needed.Conclusion
Use of RATs in primary care was accompanied by increased diagnostic activity and additional cancer diagnoses. 相似文献19.
Helen Atherton Yannis Pappas Carl Heneghan Elizabeth Murray 《The British journal of general practice》2013,63(616):e760-e767
Background
Reports suggest approximately 21–23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice.Aim
To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts.Design and setting
A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs.Method
A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved.Results
In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the ‘rules of engagement’ in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance.Conclusion
Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients. 相似文献20.