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Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study

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ABSTRACT

Background: Delayed diagnosis in primary care is a common, harmful and costly patient safety incident. Its measurement and monitoring are underdeveloped and underutilised. We created and implemented a novel approach to identify problems leading to and solutions for delayed diagnosis in primary care.

Methods: We developed a novel priority-setting method for patient safety problems and solutions called PRIORITIZE. We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to delayed diagnosis in primary care. 113 clinicians submitted their suggestions which were thematically grouped and synthesized into a composite list of 33 distinct problems and 27 solutions. A random group of 75 clinicians from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the Average Expert Agreement.

Results: The top ranked problems were poor communication between secondary and primary care and the inverse care law, i.e. a mismatch between patients’ medical needs and healthcare supply. The highest ranked solutions included: a more rigorous system of communicating abnormal results of investigations to patients, direct hotlines to specialists for GPs to discuss patient problems and better training of primary care clinicians in relevant areas. A priority highlighted throughout the findings is a need to improve communication between clinicians as well as with patients. The highest ranked suggestions had the highest consensus between experts.

Conclusions: The novel method we have developed is highly feasible, informative and scalable, and merits wider exploration with a view of becoming part of a routine pro-active and preventative system for patient safety assessment. Clinicians proposed a range of concrete suggestions with an emphasis on improving communication among clinicians and with patients and better GP training. In their view, delayed diagnosis can be largely prevented with interventions requiring relatively minor investment. Rankings of identified problems and solutions can serve as an aid to policy makers and commissioners of care in prioritization of scarce healthcare resources.

Electronic supplementary material: The online version of this article (doi:10.1186/s12875-016-0530-z) contains supplementary material, which is available to authorized users.

No MeSH data available.


Participants flow diagram
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Fig2: Participants flow diagram

Mentions: In the first phase we invited > 500 primary care clinicians and received 113 completed questionnaires (response rate ~22.6 %) with the majority completed by GPs (n = 85, 75.2 %) (Additional file 4). They proposed 173 problems and 112 solutions relating to delayed diagnosis that were thematically merged into 33 distinct problems and 27 solutions. From the phase 1 cohort, 168 randomly selected GPs were invited to score the composite list of suggestions resulting in 66 fully completed scoring sheets (Fig. 2).Fig. 2


Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study
Participants flow diagram
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5017013&req=5

Fig2: Participants flow diagram
Mentions: In the first phase we invited > 500 primary care clinicians and received 113 completed questionnaires (response rate ~22.6 %) with the majority completed by GPs (n = 85, 75.2 %) (Additional file 4). They proposed 173 problems and 112 solutions relating to delayed diagnosis that were thematically merged into 33 distinct problems and 27 solutions. From the phase 1 cohort, 168 randomly selected GPs were invited to score the composite list of suggestions resulting in 66 fully completed scoring sheets (Fig. 2).Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Delayed diagnosis in primary care is a common, harmful and costly patient safety incident. Its measurement and monitoring are underdeveloped and underutilised. We created and implemented a novel approach to identify problems leading to and solutions for delayed diagnosis in primary care.

Methods: We developed a novel priority-setting method for patient safety problems and solutions called PRIORITIZE. We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to delayed diagnosis in primary care. 113 clinicians submitted their suggestions which were thematically grouped and synthesized into a composite list of 33 distinct problems and 27 solutions. A random group of 75 clinicians from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the Average Expert Agreement.

Results: The top ranked problems were poor communication between secondary and primary care and the inverse care law, i.e. a mismatch between patients’ medical needs and healthcare supply. The highest ranked solutions included: a more rigorous system of communicating abnormal results of investigations to patients, direct hotlines to specialists for GPs to discuss patient problems and better training of primary care clinicians in relevant areas. A priority highlighted throughout the findings is a need to improve communication between clinicians as well as with patients. The highest ranked suggestions had the highest consensus between experts.

Conclusions: The novel method we have developed is highly feasible, informative and scalable, and merits wider exploration with a view of becoming part of a routine pro-active and preventative system for patient safety assessment. Clinicians proposed a range of concrete suggestions with an emphasis on improving communication among clinicians and with patients and better GP training. In their view, delayed diagnosis can be largely prevented with interventions requiring relatively minor investment. Rankings of identified problems and solutions can serve as an aid to policy makers and commissioners of care in prioritization of scarce healthcare resources.

Electronic supplementary material: The online version of this article (doi:10.1186/s12875-016-0530-z) contains supplementary material, which is available to authorized users.

No MeSH data available.