scholarly journals 567P_PR Diagnostic delay in oncology: Is there a need for increasing cancer awareness among primary care physicians of developing countries?

2016 ◽  
Vol 27 ◽  
pp. ix185
Author(s):  
R. Miriyala ◽  
A. Bansal ◽  
C. Dracham ◽  
P. Thakur ◽  
S. Ghoshal
Keyword(s):  
Primary Care ◽  
Developing Countries ◽  
Primary Care Physicians ◽  
Diagnostic Delay ◽  
Cancer Awareness

scholarly journals Primary care physician perspectives on barriers to diagnosing axial Spondyloarthritis: a qualitative study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kate L. Lapane ◽  
Sara Khan ◽  
Divya Shridharmurthy ◽  
Ariel Beccia ◽  
Catherine Dubé ◽  
...  
Keyword(s):  
Primary Care ◽  
Back Pain ◽  
Primary Care Physicians ◽  
Axial Spondyloarthritis ◽  
Diagnostic Delay ◽  
Patient Characteristics ◽  
Inflammatory Back Pain ◽  
Average Delay ◽  
Disease Characteristics ◽  
Pain Clinics

Abstract Background The average delay in diagnosis for patients with axial spondyloarthritis (axSpA) is 7 to 10 years. Factors that contribute to this delay are multifactorial and include the lack of diagnostic criteria (although classification criteria exist) for axSpA and the difficulty in distinguishing inflammatory back pain, a key symptom of axSpA, from other highly prevalent forms of low back pain. We sought to describe reasons for diagnostic delay for axSpA provided by primary care physicians. Methods We conducted a qualitative research study which included 18 US primary care physicians, balanced by gender. Physicians provided informed consent to participate in an in-depth interview (< 60 min), conducted in person (n = 3) or over the phone (n = 15), in 2019. The analysis focuses on thoughts about factors contributing to diagnostic delay in axSpA. Results Physicians noted that the disease characteristics contributing to diagnostic delay include: back pain is common and axSpA is less prevalent, slow progression of axSpA, intermittent nature of axSpA pain, and in the absence of abnormal radiographs of the spine or sacroiliac joints, there is no definitive test for axSpA. Patient characteristics believed to contribute to diagnostic delay included having multiple conditions in need of attention, infrequent interactions with the health care system, and “doctor shopping.” Doctors noted that patients wait until the last moments of the clinical encounter to discuss back pain. Problematic physician characteristics included lack of rapport with patients, lack of setting appropriate expectations, and attribution of back pain to other factors. Structural/system issues included short appointments, lack of continuity of care, insufficient insurance coverage for tests, lack of back pain clinics, and a shortage of rheumatologists. Conclusion Primary care physicians agreed that lengthy axSpA diagnosis delays are challenging to address owing to the multifactorial causes (e.g., disease characteristics, patient characteristics, lack of definitive tests, system factors).

scholarly journals How long does a myeloma patient currently wait for the diagnosis in Hungary?

2014 ◽  
Vol 155 (39) ◽  
pp. 1538-1543 ◽  
Author(s):  
Gergely Varga ◽  
Gábor Mikala ◽  
Hajnalka Andrikovics ◽  
Tamás Masszi
Keyword(s):  
Primary Care ◽  
Waiting Time ◽  
Significant Relationship ◽  
Primary Care Physicians ◽  
Early Stage ◽  
Diagnostic Delay ◽  
Myeloma Patient ◽  
Tertiary Referral ◽  
Fast Tracking ◽  
Comprehensive Study

Introduction: Long delays with the diagnosis of myeloma are common. So far there has not been a comprehensive study on this issue in Hungary. Aim: The aim of the authors was to analyze the waiting time from their first symptoms to the diagnosis of myeloma. Method: 193 myeloma patients treated in one large tertiary referral hematology centre in Hungary were included. Results: The median time was 4.1 months (0−35.4) until diagnosis, and 5.2 months (0−35.4) until treatment. The delay was longer in patients with better prognosis (early stage, low cytogenetic risk), in nonsecretory disease and in 5 patients with amyloidosis. There was no significant relationship between the delay and the survival. Conclusions: Considering the results of the present study and earlier literature data, the authors look for possibilities to improve the diagnostic delay. They think that the key to an earlier diagnosis is in the hands of the primary care physicians as they see the patients first and decide whether it is necessary to refer them to further test and to which specialty. Helping them with diagnostic algorithms, clear referring pathways, fast tracking patients with urgent problems, and making serum electrophoresis universally available in the primary care could help to reduce the time that myeloma patients spend waiting. Orv. Hetil., 2014, 155(39), 1538–1543.

scholarly journals North East London coronavirus disease 2019 protocol for diagnostics in two-week wait head and neck cancer patients

2020 ◽  
Vol 134 (8) ◽  
pp. 680-683 ◽  
Author(s):  
E Warner ◽  
D W Scholfield ◽  
A Adams ◽  
P Richards ◽  
S Ali ◽  
...  
Keyword(s):  
Primary Care ◽  
Head And Neck Cancer ◽  
High Risk ◽  
Head And Neck ◽  
Neck Cancer ◽  
Primary Care Physicians ◽  
Management Practices ◽  
Diagnostic Delay ◽  
Low Risk ◽  
Risk Patients

AbstractBackgroundThe coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread.MethodsTwo-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible.ResultsForty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging.ConclusionImplementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.

Are doctors themselves responsible for delay in cancer management?

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17027-17027
Author(s):  
R. Karwasra ◽  
S. Bhanot ◽  
R. Goel
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Common Factor ◽  
Symptomatic Treatment ◽  
Care Physician ◽  
Cancer Awareness ◽  
Medical Practitioners ◽  
Awareness Campaigns ◽  
Cancer Management ◽  
Diagnosis Of Cancer

17027 Background: In developing countries poor results of cancer management are believed to be due to late presentation of patients because of poverty, illiteracy and lack of cancer awareness. But the scenario changed little despite regular cancer awareness campaigns in last few decades. Methods: 1,006 cancer patients were assessed for time of onset of symptoms, time of presentation to physician, time taken in diagnosis & initiation of anticancer treatment to identify the level of delay in cancer management and factors responsible. Results: 81.3% of the patients belonged to low socioeconomic group. 61.9% were illiterate & 43.7% were laborers. Literacy level of 84.5% of patients was under metric level and 50.3% had no awareness about cancer. 55.4% patients presented to qualified medical practitioners, 38.9% to non-qualified medical practitioners & 5.5% to qualified non-medical practitioners working as primary care physicians. Almost 80% of patients had delay in cancer management at various levels, the maximum being at diagnosis level. 67.3% patients presented to primary care physician within a month of onset of symptoms without delay. In 68.6% patients the diagnosis of cancer was delayed by more than one month once they presented, the physicians being responsible for this delay in 60.4 % cases. Though non-qualified physicians almost never diagnosed cancer but even 58% of the qualified medical physicians delayed the diagnosis of cancer in the symptomatic patients. In 77.1% patients, physicians did not suspect cancer and disposed off the patients on symptomatic treatment. Literacy of the patients affects awareness and has bearing on the pattern of consultation whereby most of the literates consulted qualified physicians while most of the illiterates consulted non-qualified physicians resulting in delay. Conclusions: Presentation of the cancer patient depends upon reaction to the symptom and therefore despite illiteracy and poverty, majority of symptomatic patients present without delay to their primary care physicians. Delay occurs at diagnosis level in most of the patients and physician is the most common factor responsible for this delay. Tendency to treat the symptoms rather than making diagnosis of the patient and poor oncology knowledge to differentiate symptoms of cancer may be the reasons for this. No significant financial relationships to disclose.

scholarly journals THU0560 PRIMARY CARE PHYSICIAN PERSPECTIVES ON DELAYS IN DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS: A QUALITATIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 521.1-521
Author(s):  
S. H. Liu ◽  
K. Lapane ◽  
D. Shridharmurthy ◽  
S. Khan ◽  
K. Ferrucci ◽  
...  
Keyword(s):  
Primary Care ◽  
Back Pain ◽  
Primary Care Physicians ◽  
Laboratory Tests ◽  
Screening Tool ◽  
Axial Spondyloarthritis ◽  
Diagnostic Delay ◽  
Inflammatory Back Pain ◽  
Research Support ◽  
Average Delay

Background:The average delay in diagnosis for patients with any form of spondyloarthritis (SpA) ranges from 7 to 10 years [1–5]. In axial spondyloarthritis (axSpA), a subgroup of SpA, it is 5 to 14 years [4, 6, 7]. Factors that contribute to this delay include the lack of diagnostic criteria for axSpA and the difficulty in distinguishing inflammatory back pain (IBP), a key symptom of axSpA, from other highly prevalent forms of low back pain [8–10]. This impedes timely referral of these patients to rheumatologic care and initiation of appropriate treatment.Objectives:Describe understanding of, attitudes towards, and practices regarding axSpA among primary care physicians.Methods:We recruited 18 primary care physicians practicing in the United States as part of a larger qualitative study: theSpondyloArthritisScreening andEarlyDetection (SpA-SED) Study. We used purposive sampling with a goal of including an equal number of family medicine and internal medicine physicians who were balanced by gender. Physicians provided informed consent to participate in an in-depth interview (up to 60 minutes), conducted in person (n = 3) or over the phone (n = 15), between February and May 2019. The interview guide was developed by a multidisciplinary team, with input from rheumatologists. Topics included the physicians’ approaches to evaluating back pain, their awareness about axSpA, their differential diagnosis of axSpA, the laboratory tests and imaging studies ordered when axSpA is suspected, their referral patterns for patients with presumed axSpA, their thoughts about factors contributing to diagnostic delay in axSpA, and their opinions about an Inflammatory Back Pain Assessment – ASAS criteria screening tool [5].Results:Barriers to early diagnosis included patient factors (eg, multiple complaints, back pain not being the chief complaint), disease characteristics (eg, slow rate of disease progression), physician characteristics (eg, lack of rapport between patients and their primary care physicians), and structural/system issues (eg, lack of time). Most physicians reported that they would perform laboratory tests before referring a patient to a rheumatologist.Conclusion:Primary care physicians were surprised to learn of the average delay to axSpA diagnosis, considered that this lengthy delay was problematic, and agreed that improvements are needed in screening for and early detection of axSpA. Physicians believed that there would be a role for using a screening tool in the primary care setting to improve diagnostic delay, but that evidence to support its implementation is needed.References:[1]Dougados M et al.Arthritis Rheum.1991;34:1218–27.[2]Amor B et al.Rev Rhum Mal Osteoartic.1990;57:85–9.[3]van der Linden S et al.Arthritis Rheum.1984;27:361–8.[4]Deodhar A et al.Arthritis Rheumatol.2016;68:1669–76.[5]Sieper J et al.Ann Rheum Dis.2009;68:784–8.[6]Sykes MP et al.Rheumatology (Oxford).2015;54:2283–4.[7]Redeker I et al.Rheumatology (Oxford).2019;58:1634–8.[8]Strand V et al.Mayo Clin Proc.2017;92:555–64.[9]Proft F et al.Ther Adv Musculoskelet Dis. 2018;10:129–39.[10]Bohn R et al.Clin Exp Rheumatol.2018;36: 263–74.Acknowledgments:We thank the participants for sharing their insights as part of this study. This abstract was written using data from a research study originally funded by Novartis (Principal Investigator: Shao-Hsien Liu, Co-Investigators: Jonathan Kay, Kate Lapane, Catherine Dubé).Disclosure of Interests:Shao-Hsien Liu Grant/research support from: Novartis Pharmaceuticals Corporation, Kate Lapane Grant/research support from: Novartis Pharmaceuticals Corporation, Divya Shridharmurthy Grant/research support from: Novartis Pharmaceuticals Corporation, Sara Khan Grant/research support from: Novartis Pharmaceuticals Corporation, Katarina Ferrucci Grant/research support from: Novartis Pharmaceuticals Corporation, Catherine Dubé Grant/research support from: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation, Jonathan Kay Grant/research support from: Gilead Sciences, Inc., Pfizer, Novartis Pharmaceuticals Corporation, Consultant of: Alvotech Suisse AG; Arena Pharmaceuticals, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Merck Sharp & Dohme Corp.; Mylan Inc.; Novartis AG; Samsung Bioepis; Sandoz, Inc; UCB, Inc.

Ascendancy of the `Black Bottle'

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 521-522
Author(s):  
DONALD F. MACGREGOR
Keyword(s):  
Primary Care ◽  
Developing Countries ◽  
North America ◽  
Emergency Room ◽  
Activated Charcoal ◽  
Primary Care Physicians ◽  
First Line ◽  
The Public ◽  
First Line Therapy ◽  
Line Therapy

To the Editor.— Greensher et al1 commented on the increasing advice given to emergency room and primary care physicians regarding the use of activated charcoal instead of syrup of ipecac as first-line therapy for ingested toxins. This may be the direction that hospital facilities should be taking but, hopefully, will not undermine the confidence that many practitioners and the public have in syrup of ipecac. Many developing countries take their lead from North America and there are still areas on this continent where immediate emergency room access is impossible.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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