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

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....

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Autores principales: Car, Lorainne Tudor, Papachristou, Nikolaos, Bull, Adrian, Majeed, Azeem, Gallagher, Joseph, El-Khatib, Mona, Aylin, Paul, Rudan, Igor, Atun, Rifat, Car, Josip, Vincent, Charles
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017013/
https://www.ncbi.nlm.nih.gov/pubmed/27613564
http://dx.doi.org/10.1186/s12875-016-0530-z
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author Car, Lorainne Tudor
Papachristou, Nikolaos
Bull, Adrian
Majeed, Azeem
Gallagher, Joseph
El-Khatib, Mona
Aylin, Paul
Rudan, Igor
Atun, Rifat
Car, Josip
Vincent, Charles
author_facet Car, Lorainne Tudor
Papachristou, Nikolaos
Bull, Adrian
Majeed, Azeem
Gallagher, Joseph
El-Khatib, Mona
Aylin, Paul
Rudan, Igor
Atun, Rifat
Car, Josip
Vincent, Charles
author_sort Car, Lorainne Tudor
collection PubMed
description 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.
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spelling pubmed-50170132016-09-10 Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study Car, Lorainne Tudor Papachristou, Nikolaos Bull, Adrian Majeed, Azeem Gallagher, Joseph El-Khatib, Mona Aylin, Paul Rudan, Igor Atun, Rifat Car, Josip Vincent, Charles BMC Fam Pract Research Article 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. BioMed Central 2016-09-09 /pmc/articles/PMC5017013/ /pubmed/27613564 http://dx.doi.org/10.1186/s12875-016-0530-z Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Car, Lorainne Tudor
Papachristou, Nikolaos
Bull, Adrian
Majeed, Azeem
Gallagher, Joseph
El-Khatib, Mona
Aylin, Paul
Rudan, Igor
Atun, Rifat
Car, Josip
Vincent, Charles
Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study
title Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study
title_full Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study
title_fullStr Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study
title_full_unstemmed Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study
title_short Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study
title_sort clinician-identified problems and solutions for delayed diagnosis in primary care: a prioritize study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017013/
https://www.ncbi.nlm.nih.gov/pubmed/27613564
http://dx.doi.org/10.1186/s12875-016-0530-z
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