Responsibility for follow-up during the diagnostic process in primary care : A secondary analysis of International Cancer Benchmarking Partnership data
(2018) In British Journal of General Practice 68(670). p.323-332- Abstract
Background: It is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained. Aim: To explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions. Design and setting: A secondary analysis of survey data from the International Cancer Benchmarking Partnership. Method: The authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK... (More)
Background: It is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained. Aim: To explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions. Design and setting: A secondary analysis of survey data from the International Cancer Benchmarking Partnership. Method: The authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK estimates were compared with non-UK ones. Free-text responses were analysed to contextualise quantitative findings using a modified grounded theory approach. Results: PCPs varied in their retention of responsibility for follow-up from 19% to 97% across jurisdictions and area of follow-up. Test reconciliation was inadequate in most jurisdictions. Significantly fewer UK PCPs retained responsibility for test result communication (73% versus 85%, P = 0.04) and non-attender follow-up (78% versus 93%, P<0.01) compared with non-UK PCPs. PCPs have developed bespoke, inconsistent solutions to follow-up. In cases of greatest concern, 'double safety netting' is described, where both patient and PCP retain responsibility. Conclusion: The degree to which PCPs retain responsibility for follow-up is dependent on their level of concern about the patient and their primary care system's properties. Integrated systems to support follow-up are at present underutilised, and research into their development, uptake, and effectiveness seems warranted.
(Less)
- author
- Nicholson, Brian D. ; Goyder, Clare R. ; Bankhead, Clare R. ; Toftegaard, Berit S. ; Rose, Peter W. ; Thulesius, Hans LU ; Vedsted, Peter and Perera, Rafael
- organization
- publishing date
- 2018-05-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cancer, Diagnosis, Diagnostic errors, Diagnostic safety, General practice, Primary care, Safety netting
- in
- British Journal of General Practice
- volume
- 68
- issue
- 670
- pages
- 323 - 332
- publisher
- Royal College of General Practitioners
- external identifiers
-
- scopus:85045995362
- pmid:29686134
- ISSN
- 0960-1643
- DOI
- 10.3399/bjgp18X695813
- language
- English
- LU publication?
- yes
- id
- fc51da47-80e7-4103-939f-477eb19f21b7
- date added to LUP
- 2018-05-04 15:22:59
- date last changed
- 2024-06-10 12:10:17
@article{fc51da47-80e7-4103-939f-477eb19f21b7,
abstract = {{<p>Background: It is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained. Aim: To explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions. Design and setting: A secondary analysis of survey data from the International Cancer Benchmarking Partnership. Method: The authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK estimates were compared with non-UK ones. Free-text responses were analysed to contextualise quantitative findings using a modified grounded theory approach. Results: PCPs varied in their retention of responsibility for follow-up from 19% to 97% across jurisdictions and area of follow-up. Test reconciliation was inadequate in most jurisdictions. Significantly fewer UK PCPs retained responsibility for test result communication (73% versus 85%, P = 0.04) and non-attender follow-up (78% versus 93%, P<0.01) compared with non-UK PCPs. PCPs have developed bespoke, inconsistent solutions to follow-up. In cases of greatest concern, 'double safety netting' is described, where both patient and PCP retain responsibility. Conclusion: The degree to which PCPs retain responsibility for follow-up is dependent on their level of concern about the patient and their primary care system's properties. Integrated systems to support follow-up are at present underutilised, and research into their development, uptake, and effectiveness seems warranted.</p>}},
author = {{Nicholson, Brian D. and Goyder, Clare R. and Bankhead, Clare R. and Toftegaard, Berit S. and Rose, Peter W. and Thulesius, Hans and Vedsted, Peter and Perera, Rafael}},
issn = {{0960-1643}},
keywords = {{Cancer; Diagnosis; Diagnostic errors; Diagnostic safety; General practice; Primary care; Safety netting}},
language = {{eng}},
month = {{05}},
number = {{670}},
pages = {{323--332}},
publisher = {{Royal College of General Practitioners}},
series = {{British Journal of General Practice}},
title = {{Responsibility for follow-up during the diagnostic process in primary care : A secondary analysis of International Cancer Benchmarking Partnership data}},
url = {{http://dx.doi.org/10.3399/bjgp18X695813}},
doi = {{10.3399/bjgp18X695813}},
volume = {{68}},
year = {{2018}},
}