scholarly journals Does the Primary Care Experience Influence the Cancer Diagnostic Process?

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Sylvie Provost ◽  
Raynald Pineault ◽  
Pierre Tousignant ◽  
Danièle Roberge ◽  
Dominique Tremblay ◽  
...  
Keyword(s):  
Primary Care ◽  
Metastatic Cancer ◽  
Diagnostic Process ◽  
Process Time ◽  
Care Experience ◽  
Usual Source ◽  
Point Of Entry ◽  
Experience Of Care ◽  
Time To Diagnosis ◽  
The Impact

Objective. To analyze the impact of patients’ experience of care at their usual source of primary care on their choice of point of entry into cancer investigation process, time to diagnosis, and presence of metastatic cancer at time of diagnosis. Method. A questionnaire was administered to 438 patients with cancer (breast, lung, and colorectal) between 2011 and 2013 in four oncology clinics of Quebec (Canada). Multiple regression analyses (logistic and Cox models) were conducted. Results. Among patients with symptoms leading to investigation of cancer (n=307), 47% used their usual source of primary care as the point of entry for investigation. Greater comprehensiveness of care was associated with the decision to use this source as point of entry (OR = 1.25; CI 90% = 1.06–1.46), as well as with shorter times between first symptoms and investigation (HR = 1.11; p=0.05), while greater accessibility was associated with shorter times between investigation and diagnosis (HR = 1.13; p<0.01).  Conclusion. Experience of care at the usual source of primary care has a slight influence on the choice of point of entry for cancer investigation and on time to diagnosis. This influence appears to be more related to patients’ perceptions of the accessibility and comprehensiveness of their usual source of primary care.

scholarly journals Routes to Diagnosis for Suspected Sarcoma: The Impact of Symptoms and Clinical Findings on the Diagnostic Process

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Heidi Buvarp Dyrop ◽  
Peter Vedsted ◽  
Mathias Rædkjær ◽  
Akmal Safwat ◽  
Johnny Keller
Keyword(s):  
Primary Care ◽  
Clinical Findings ◽  
Diagnostic Process ◽  
Time Intervals ◽  
Local Hospital ◽  
Doctor Visit ◽  
Presenting Symptoms ◽  
One Year ◽  
The Impact ◽  
Diagnostic Intervals

Background and Objectives. Sarcoma patients often experience delay before diagnosis. We examined the association between presenting symptoms/signs and time intervals for suspected sarcoma patients.Methods. 545 consecutive patients suspected for sarcoma referred over a one-year period were included. Median time intervals in routes to diagnosis were collected from medical records and questionnaires.Results. 102 patients (18.7%) had a sarcoma; 68 (12.5%) had other malignancies. Median interval for the patient (time from first symptom to first doctor visit), primary care, local hospital, sarcoma center, diagnostic, and total interval for sarcoma patients were 77, 17, 29, 17, 65, and 176 days, respectively. Sarcoma patients visited more hospital departments and had longer median primary care (+10 days) and diagnostic intervals (+19 days) than patients with benign conditions. Median primary care (−19 days) and sarcoma center (−4 days) intervals were shorter for patients with a lump versus no lump. Median patient (+40 days), primary care (+12 days), diagnostic (+17 days), and total intervals (+78 days) were longer for patients presenting with pain versus no pain. GP suspicion of malignancy shortened local hospital (−20 days) and total intervals (−104 days).Conclusions. The main part of delay could be attributed to the patient and local hospitals. Length of time intervals was associated with presenting symptoms/signs and GP suspicion.

scholarly journals Patient Reported Experiences and Delays During the Diagnostic Pathway for Pulmonary Fibrosis: A Multinational European Survey

2021 ◽  
Vol 8 ◽  
Author(s):  
Iris G. van der Sar ◽  
Steve Jones ◽  
Deborah L. Clarke ◽  
Francesco Bonella ◽  
Jean Michel Fourrier ◽  
...  
Keyword(s):  
Primary Care ◽  
Pulmonary Fibrosis ◽  
Final Diagnosis ◽  
Diagnostic Process ◽  
Sufficient Information ◽  
Diagnostic Pathway ◽  
Hospital Referral ◽  
Initial Symptoms ◽  
Patient Reported ◽  
Time To Diagnosis

Introduction: Pulmonary fibrosis includes a spectrum of diseases and is incurable. There is a variation in disease course, but it is often progressive leading to increased breathlessness, impaired quality of life, and decreased life expectancy. Detection of pulmonary fibrosis is challenging, which contributes to considerable delays in diagnosis and treatment. More knowledge about the diagnostic journey from patients' perspective is needed to improve the diagnostic pathway. The aims of this study were to evaluate the time to diagnosis of pulmonary fibrosis, identify potential reasons for delays, and document patients emotions.Methods: Members of European patient organisations, with a self-reported diagnosis of pulmonary fibrosis, were invited to participate in an online survey. The survey assessed the diagnostic pathway retrospectively, focusing on four stages: (1) time from initial symptoms to first appointment in primary care; (2) time to hospital referral; (3) time to first hospital appointment; (4) time to final diagnosis. It comprised open-ended and closed questions focusing on time to diagnosis, factors contributing to delays, diagnostic tests, patient emotions, and information provision.Results: Two hundred and seventy three participants (214 idiopathic pulmonary fibrosis, 28 sarcoidosis, 31 other) from 13 countries responded. Forty percent of individuals took ≥1 year to receive a final diagnosis. Greatest delays were reported in stage 1, with only 50.2% making an appointment within 3 months. For stage 2, 73.3% reported a hospital referral within three primary care visits. However, 9.9% reported six or more visits. After referral, 76.9% of patients were assessed by a specialist within 3 months (stage 3) and 62.6% received a final diagnosis within 3 months of their first hospital visit (stage 4). Emotions during the journey were overall negative. A major need for more information and support during and after the diagnostic process was identified.Conclusion: The time to diagnose pulmonary fibrosis varies widely across Europe. Delays occur at each stage of the diagnostic pathway. Raising awareness about pulmonary fibrosis amongst the general population and healthcare workers is essential to shorten the time to diagnosis. Furthermore, there remains a need to provide patients with sufficient information and support at all stages of their diagnostic journey.

scholarly journals Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit

2017 ◽  
Vol 68 (666) ◽  
pp. e63-e72 ◽  
Author(s):  
Ruth Swann ◽  
Sean McPhail ◽  
Jana Witt ◽  
Brian Shand ◽  
Gary A Abel ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Clinical Audit ◽  
Patient Characteristics ◽  
Diagnostic Process ◽  
Comorbid Condition ◽  
Key Aspects ◽  
New Diagnosis ◽  
Diagnostic Delays ◽  
The Impact

BackgroundContinual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this.AimTo characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit.Design and settingClinical audit of cancer diagnosis in general practices in England.MethodInformation on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management.ResultsData were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15–86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0–27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more.ConclusionThe findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer.

scholarly journals The Impact of a Concussion Clinic on Family Medicine Resident Education

PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Theodore A. Ogren ◽  
Alexander C. Knobloch
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Sports Medicine ◽  
Resident Education ◽  
Improvement Project ◽  
Medicine Resident ◽  
Point Of Entry ◽  
Personal Value ◽  
The Impact ◽  
Academic Year

Introduction: Given that primary care has been found to be the most likely point of entry into the health care system for concussion patients, diagnosis and management of concussions are vital to the education of family medicine physicians. Studies of primary care residencies reveal a self-perceived deficiency in sports medicine education. This project was designed to determine the effect of a concussion management clinic on family medicine residents’ confidence in and personal value placed on diagnosing and managing concussions.  Methods: This project was completed in a family medicine residency as a retrospective evaluation of an educational improvement project during the 2016-2017 academic year. The intervention involved implementation of a structured clinical experience focused on management of concussions. Residents were surveyed preintervention, as well as 5 and 11 months postintervention, measuring resident exposure to and confidence in diagnosing and managing concussions.  Results: Residents demonstrated significantly increased confidence in diagnosing concussions and managing complicated concussions following the intervention (both F [2, 84]=3.56, P=0.03). Post hoc analysis indicated the statistical difference was found between preintervention measures and 1 academic year later. The number of concussions seen positively correlated with resident confidence in both diagnosing and managing concussions while personal value remained high. Conclusions: This project is the first to evaluate the impact of a concussion clinic on resident education, demonstrating significant improvement in multiple areas of concussion education. Replicating the project in other family medicine residencies could be beneficial in determining if this clinic education model improves resident outcomes in other residencies. 

The Influence of Individuals’ Vulnerabilities and Their Interactions on the Assessment of a Primary Care Experience

2018 ◽  
Vol 48 (4) ◽  
pp. 798-819
Author(s):  
Ola M. Haidar ◽  
Paul A. Lamarche ◽  
Jean-Frederic Levesque ◽  
Robert Pampalon
Keyword(s):  
Primary Care ◽  
Negative Influence ◽  
Simultaneous Presence ◽  
Care Experience ◽  
Experience Of Care ◽  
Different Types ◽  
Positive Assessment ◽  
Health Related ◽  
The Relationship ◽  
Positive Effect

This study examines the relationship between the vulnerabilities of individuals and their assessments of their primary care experiences in the setting of a universal care system. It focuses on 2 specific objectives: (1) evaluating the influence of each of the 5 vulnerabilities on the assessment of the care experience; (2) evaluating the influence of the interactions between the different types of vulnerabilities on the assessment of the care experience. The study identifies the primary care experience of 9,206 people. The health-related, biological, material, relational, and cultural vulnerabilities are also evaluated. Generally, individuals’ vulnerabilities are associated with a positive assessment of the primary care experience except for the cultural vulnerability. Material vulnerability is most frequently associated with a positive assessment of the primary care experience. The interactions between the multiple vulnerabilities present for one individual often modify the effect of vulnerability on the assessment of the experience of care. The positive effect of a vulnerability on the assessment of the care experience often increases in the presence of a second vulnerability, especially the health-related vulnerability. The simultaneous presence of health-related vulnerability cancels the negative influence of cultural vulnerability on the assessment of the primary care experience.

scholarly journals Audit of the impact of the York faecal calprotectin care pathway on colonoscopy activity

2019 ◽  
Vol 11 (4) ◽  
pp. 285-289
Author(s):  
James Turvill ◽  
Daniel Turnock
Keyword(s):  
Primary Care ◽  
Care Pathway ◽  
Teaching Hospitals ◽  
Colonic Disease ◽  
Faecal Calprotectin ◽  
Number Of Patients ◽  
Time To Diagnosis ◽  
Clinical Diagnoses ◽  
Irritable Bowel ◽  
The Impact

BackgroundThe York faecal calprotectin care pathway (YFCCP) was developed to optimise effective primary care differentiation between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). We undertook an audit of colonoscopy activity at York Teaching Hospitals after the introduction of the YFCCP, to assess its impact.MethodsFaecal calprotectin (FC) results were reconciled with colonoscopy activity in patients 18–60 years after the implementation of the YFCCP. This permitted individual patient tracking of their FC values, the timing of those requests by primary care, the date of subsequent referral and investigation and the end clinical diagnoses.ResultsPrimary care uptake of FC increased fourfold with the introduction of the YFCCP. Following implementation, FC-related referrals for colonoscopy fell from 24% to 13%. The number of patients needed to colonoscope to diagnose organic colonic disease (IBD, significant adenomatous polyps or colorectal cancer) fell from 6.8 to 3.8 when the YFCCP was applied. This represents a cost saving of £41 015 per thousand patients tested in primary care. We estimate that outpatient time to diagnosis fell from a median of 41 to 29 days.ConclusionThis audit of FC activity and colonoscopy outcomes provides substantial supportive evidence for the effectiveness of the YFCCP. Popular in primary care, it has led to a reduction in referrals. The diagnostic accuracy determined in this audit is in line with earlier evaluations. Accepting the weaknesses of audit we conclude that this evaluation likely underestimates the benefits of the YFCCP in terms of resource use saving and time to diagnosis.

scholarly journals P166 Impact of consultation frequency and time to diagnosis on subsequent Inflammatory Bowel Disease outcomes

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S242-S243
Author(s):  
N Jayasooriya ◽  
S Saxena ◽  
J Blackwell ◽  
I Petersen ◽  
A Bottle ◽  
...  
Keyword(s):  
Primary Care ◽  
Inflammatory Bowel Disease ◽  
Disease Outcomes ◽  
Gi Symptoms ◽  
Time To Diagnosis ◽  
Care Consultation ◽  
Inflammatory Bowel ◽  
Incident Cases ◽  
The Impact ◽  
Subsequent Risk

Abstract Background The impact of length of time between the point of initial contact, at symptom onset, with a health-care provider and diagnosis of inflammatory bowel disease (IBD) on subsequent disease outcomes, is unclear. Diagnosis can be challenging and delay common, with an excess of gastrointestinal (GI) symptoms reported 3 years before the diagnosis of IBD compared to the background population.1 We describe the impact of time to diagnosis and frequency of consultation amongst individuals with GI symptoms who later go on to develop ulcerative colitis (UC) and Crohn’s disease (CD). Methods Using the Clinical Practice Research Datalink, a nationally representative research database, incident cases of IBD were identified between 2003 and 2016. GI symptoms were defined as abdominal pain, diarrhoea, or rectal bleeding. The proportion of individuals consulting for incident GI symptoms within 3 years prior to IBD diagnosis was identified. Using a multivariable regression model we evaluated the association between time to diagnosis from incident consultation and consultation frequency for GI symptoms on disease outcomes (corticosteroid (CS) and thiopurine (TP) use, hospitalisation and major abdominal surgery) 5 years after IBD diagnosis. Results Six thousand nine hundred and sixty-seven incident cases of IBD were identified during the study period. Within 3 years prior to IBD diagnosis, 2,645 (38%) patients had an incident presentation with GI symptoms in primary care (782 CD, 1,863 UC). Presentation with GI symptoms occurred &gt;3 years before IBD diagnosis in 2,842 (41%) of patients. There was no recorded primary care consultation for 1,480 (21%) patients. Time to diagnosis from initial consultation was not associated with worse subsequent disease outcomes. However, amongst patients later diagnosed with UC, ≥3 prior consultations for GI symptoms was associated with an increased subsequent risk of CS use (HR 1.19, 95% CI 1.05 -1.36), CS dependency (HR 1.50, 95% CI 1.10 -2.05), TP use (HR 1.60, 95% CI 1.22 – 2.11) and colectomy (HR 1.91, 95% CI 1.21 – 3.04). Amongst patients with CD, ≥3 prior consultations were associated with an increased subsequent risk of major abdominal surgery (HR 1.75, 95% CI 1.22 -2.5) and hospitalisation (HR 1.58, 95% CI 1.18 -2.11) Conclusion Frequent primary care consultation with GI symptoms, but not symptom duration prior to IBD diagnosis, was associated with worse subsequent disease outcomes. Steps are needed to expedite IBD diagnosis to reduce the risk of adverse disease outcomes. Reference

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

Sign in / Sign up

Export Citation Format

Share Document