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Responsibility for follow-up during the diagnostic process in primary care : A secondary analysis of International Cancer Benchmarking Partnership data

Nicholson, Brian D.; Goyder, Clare R.; Bankhead, Clare R.; Toftegaard, Berit S.; Rose, Peter W.; Thulesius, Hans LU ; Vedsted, Peter and Perera, Rafael (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.

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author
organization
publishing date
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
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
2019-02-20 11:16:15
@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&lt;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},
  keyword      = {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},
  volume       = {68},
  year         = {2018},
}