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Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives

OBJECTIVE: To understand how service factors contribute to delays to specialist assessment following transient ischaemic attack (TIA) or minor stroke. DESIGN: Qualitative study using semistructured interviews, analysis by constant comparison. SETTING: Leicester, UK. PARTICIPANTS: Patients diagnosed...

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Autores principales: Wilson, Andrew, Coleby, Dawn, Regen, Emma, Phelps, Kay, Windridge, Kate, Willars, Janet, Robinson, Tom
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874118/
https://www.ncbi.nlm.nih.gov/pubmed/27188815
http://dx.doi.org/10.1136/bmjopen-2016-011654
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author Wilson, Andrew
Coleby, Dawn
Regen, Emma
Phelps, Kay
Windridge, Kate
Willars, Janet
Robinson, Tom
author_facet Wilson, Andrew
Coleby, Dawn
Regen, Emma
Phelps, Kay
Windridge, Kate
Willars, Janet
Robinson, Tom
author_sort Wilson, Andrew
collection PubMed
description OBJECTIVE: To understand how service factors contribute to delays to specialist assessment following transient ischaemic attack (TIA) or minor stroke. DESIGN: Qualitative study using semistructured interviews, analysis by constant comparison. SETTING: Leicester, UK. PARTICIPANTS: Patients diagnosed with TIA or minor stroke, at hospital admission or in a rapid-access TIA clinic (n=42), general practitioners (GPs) of participating patients if they had been involved in the patients’ care (n=18). DATA: Accounts from patients and GPs of factors contributing to delay following action to seek help from a healthcare professional (HCP). RESULTS: The following categories of delay were identified. First, delay in assessment in general practice following contact with the service; this related to availability of same day appointments, and the role of the receptionist in identifying urgent cases. Second, delays in diagnosis by the HCP first consulted, including GPs, optometrists, out-of-hours services, walk-in centres and the emergency department. Third, delays in referral after a suspected diagnosis; these included variable use of the ABCD(2) (Age, Blood pressure, Clinical features, Duration, Diabetes) risk stratification score and referral templates in general practice, and referral back to the patients’ GP in cases where he/she was not the first HCP consulted. CONCLUSIONS: Primary and emergency care providers need to review how they can best handle patients presenting with symptoms that could be due to stroke or TIA. In general practice, this may include receptionist training and/or triage by a nurse or doctor. Mechanisms need to be established to enable direct referral to the TIA clinic when patients whose symptoms have resolved present to other agencies. Further work is needed to improve diagnostic accuracy by non-specialists.
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spelling pubmed-48741182016-05-27 Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives Wilson, Andrew Coleby, Dawn Regen, Emma Phelps, Kay Windridge, Kate Willars, Janet Robinson, Tom BMJ Open Cardiovascular Medicine OBJECTIVE: To understand how service factors contribute to delays to specialist assessment following transient ischaemic attack (TIA) or minor stroke. DESIGN: Qualitative study using semistructured interviews, analysis by constant comparison. SETTING: Leicester, UK. PARTICIPANTS: Patients diagnosed with TIA or minor stroke, at hospital admission or in a rapid-access TIA clinic (n=42), general practitioners (GPs) of participating patients if they had been involved in the patients’ care (n=18). DATA: Accounts from patients and GPs of factors contributing to delay following action to seek help from a healthcare professional (HCP). RESULTS: The following categories of delay were identified. First, delay in assessment in general practice following contact with the service; this related to availability of same day appointments, and the role of the receptionist in identifying urgent cases. Second, delays in diagnosis by the HCP first consulted, including GPs, optometrists, out-of-hours services, walk-in centres and the emergency department. Third, delays in referral after a suspected diagnosis; these included variable use of the ABCD(2) (Age, Blood pressure, Clinical features, Duration, Diabetes) risk stratification score and referral templates in general practice, and referral back to the patients’ GP in cases where he/she was not the first HCP consulted. CONCLUSIONS: Primary and emergency care providers need to review how they can best handle patients presenting with symptoms that could be due to stroke or TIA. In general practice, this may include receptionist training and/or triage by a nurse or doctor. Mechanisms need to be established to enable direct referral to the TIA clinic when patients whose symptoms have resolved present to other agencies. Further work is needed to improve diagnostic accuracy by non-specialists. BMJ Publishing Group 2016-05-17 /pmc/articles/PMC4874118/ /pubmed/27188815 http://dx.doi.org/10.1136/bmjopen-2016-011654 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Cardiovascular Medicine
Wilson, Andrew
Coleby, Dawn
Regen, Emma
Phelps, Kay
Windridge, Kate
Willars, Janet
Robinson, Tom
Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives
title Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives
title_full Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives
title_fullStr Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives
title_full_unstemmed Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives
title_short Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives
title_sort service factors causing delay in specialist assessment for tia and minor stroke: a qualitative study of gp and patient perspectives
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874118/
https://www.ncbi.nlm.nih.gov/pubmed/27188815
http://dx.doi.org/10.1136/bmjopen-2016-011654
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