scholarly journals 832 Groin Hernia Should Remain A Clinical Diagnosis -- An Evidence-Based Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Abu Elgasim ◽  
A Conroy ◽  
M R Cartland ◽  
P Sridhar
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Groin Hernia ◽  
Clinical Findings ◽  
Ultrasound Finding ◽  
Positive Finding ◽  
Surgical Department ◽  
Retrospective Audit ◽  
Operative Findings

Abstract Introduction British Hernia Society (BHS) 2013 guidelines1 suggest that groin hernia diagnostic investigation should not be done at the primary care level. Nevertheless, General Practitioners refer patients with a positive ultrasound finding of groin hernia to secondary care. As a result, patients have false hopes that their symptoms would resolve if the ultrasound finding is addressed. The study aims to find the positive predictive value (PPV) for groin ultrasound for hernia and should the primary care physicians request the scan before referral to secondary care. Method A retrospective audit of outcome of patients referred to a general surgical department for groin hernia treatment. The study looked at elective groin hernia referrals for the period between June and August 2019. Results 127 patients were electively treated for groin hernia in secondary care. 40% of the patients had ultrasounds before treatment. The GP requested 78% of the ultrasounds. A positive finding was the reason for the referral. Two patients (5%) in this group had negative operative findings. 24 herniograms over 57 months for patients referred with positive ultrasound and negative clinical findings showed only 2 had positive findings (8%). None of the negative patients returned to the same hospital for groin hernia treatment until date. Conclusions It is recommended that the diagnostic tests for groin hernia be requested by the operating surgeon as per the BHS guidelines. Patients should not be subjected to hernia operations based on ultrasound findings as the PPV for this investigation is very low for patients who have negative clinical findings.2

The pathway to diagnosis and treatment for surgically managed lung cancer patients

2019 ◽  
Author(s):  
Victoria White ◽  
Rebecca J Bergin ◽  
Robert J Thomas ◽  
Kathryn Whitfield ◽  
David Weller
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Cancer Patients ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Treatment Time ◽  
Early Stage ◽  
Diagnosis And Treatment ◽  
Early Stage Disease ◽  
Lung Cancer Patients

Abstract Background Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis. Methods Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or ‘investigation’ of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age. Results One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than ‘investigation’ patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant. Conclusion Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways.

scholarly journals Patient-Care Questions that Physicians Are Unable to Answer

2007 ◽  
Vol 14 (4) ◽  
pp. 407-414 ◽  
Author(s):  
John W. Ely ◽  
Jerome A. Osheroff ◽  
Saverio M. Maviglia ◽  
Marcy E. Rosenbaum
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Primary Care Physicians ◽  
Clinical Information ◽  
Clinical Findings ◽  
Information Resources ◽  
Clinical Information Systems ◽  
Unanswered Question ◽  
Test Results ◽  
Clinical Questions

Abstract Objective: To describe the characteristics of unanswered clinical questions and propose interventions that could improve the chance of finding answers. Design: In a previous study, investigators observed primary care physicians in their offices and recorded questions that arose during patient care. Questions that were pursued by the physician, but remained unanswered, were grouped into generic types. In the present study, investigators attempted to answer these questions and developed recommendations aimed at improving the success rate of finding answers. Measurements: Frequency of unanswered question types and recommendations to increase the chance of finding answers. Results: In an earlier study, 48 physicians asked 1062 questions during 192 half-day office observations. Physicians could not find answers to 237 (41%) of the 585 questions they pursued. The present study grouped the unanswered questions into 19 generic types. Three types accounted for 128 (54%) of the unanswered questions: (1) “Undiagnosed finding” questions asked about the management of abnormal clinical findings, such as symptoms, signs, and test results (What is the approach to finding X?); (2) “Conditional” questions contained qualifying conditions that were appended to otherwise simple questions (What is the management of X, given Y? where “given Y” is the qualifying condition that makes the question difficult.); and (3) “Compound” questions asked about the association between two highly specific elements (Can X cause Y?). The study identified strategies to improve clinical information retrieval, listed below. Conclusion: To improve the chance of finding answers, physicians should change their search strategies by rephrasing their questions and searching more clinically oriented resources. Authors of clinical information resources should anticipate questions that may arise in practice, and clinical information systems should provide clearer and more explicit answers.

scholarly journals Acute General Practice – the 7 year itch

2015 ◽  
Vol 14 (3) ◽  
pp. 132-135
Author(s):  
Ben Jameson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Patient Care ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Service Design ◽  
Improve Patient Care ◽  
Medical Assessment ◽  
Improve Patient

The Acute GP Service has operated in Plymouth for the last 7 years. We have a mandate to improve patient care through supporting community GPs and their patients at the point of need for urgent medical assessment. I outline our service design and delivery and make the argument for the use of primary care physicians to help manage the interface between primary and secondary care.

scholarly journals Age-related hearing loss and provider-patient communication across primary and secondary care settings: a cross-sectional study

2020 ◽  
Vol 49 (5) ◽  
pp. 873-877 ◽  
Author(s):  
Simon Smith ◽  
Nur Syifa Ilyani Abd Manan ◽  
Shannon Toner ◽  
Amr Al Refaie ◽  
Nicole Müller ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Hearing Loss ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Formal Training ◽  
Care Providers ◽  
Age Related ◽  
Age Related Hearing Loss

Abstract Background The prevalence of age-related hearing loss (ARHL) increases with age. Older adults are amongst the most dependent users of healthcare and most vulnerable to medical error. This study examined health professionals’ strategies, as well as level of formal training completed, for communication with older adults with ARHL, and their views on the contribution of ARHL to suboptimal quality of patient care. Methods A 17-item questionnaire was distributed to a sample of Irish primary care physicians, as well as hospital-based clinicians providing inpatient palliative care and geriatric services. Results A total of 172 primary care physicians and 100 secondary care providers completed the questionnaire. A total of 154 (90%) primary and 97 (97%) secondary care providers agreed that ARHL had a negative impact on quality of care. Across both settings, 10% of respondents reported that communication issues contributed to multiple medication error events each year. Although only 3.5% of secondary care providers and 13% of primary care physicians attended formal training on communication with hearing-impaired patients, 66.5% of respondents were confident in their capacity to communicate with these patients. Primary care physicians reported that they either never used assistive hearing technology (44%) or were unfamiliar with this technology (49%). Conclusions Primary and secondary care health providers reported that ARHL reduces patient care quality and may initiate errors leading to patient harm. Formal training addressing the communication needs of ARHL patients appears to be underdeveloped, and there is a limited familiarity with assistive hearing technology. This is both an error in health professional training and healthcare services.

scholarly journals Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: a qualitative study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703421
Author(s):  
Sarah Charman ◽  
Nduka Okwose ◽  
Gregory Maniatopoulos ◽  
Sara Graziadio ◽  
Luke Vale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Qualitative Study ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Clinical Test ◽  
Output Response ◽  
Response To Stress

BackgroundPrimary care physicians lack access to an objective cardiac function test during diagnostic testing for suspected heart failure.AimTo determine the role of the novel Cardiac Output Response to Stress (CORS) test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.MethodQualitative study using semi-structured in-depth interviews which were audiorecorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach. Fourteen healthcare professionals (six males, eight females) from primary (GPs, nurses, healthcare assistants, and practice managers) and secondary care (consultant cardiologists) participated.ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include establishment of clinical utility, suitability for immobile patients, and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose however, factors such as cost-effectiveness, diagnostic accuracy, and seamless implementation in primary care have to be fully explored.

scholarly journals N25 Outcomes of a GP outreach programme to offer colonoscopic surveillance for IBD patients being managed in primary care

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S668-S669
Author(s):  
H Windak ◽  
V Cairnes ◽  
N Chanchlani ◽  
C Desmond ◽  
B Hamilton ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Clinical Excellence ◽  
Distant Metastases ◽  
Right Hemicolectomy ◽  
Colonoscopic Surveillance ◽  
Outreach Programme ◽  
Nice Guidance ◽  
Patient Information Booklets

Abstract Background Colonoscopic surveillance in IBD patients can reduce the development of colorectal cancer (CRC) and the rate of CRC-associated death. We recently reported that 27% of IBD patients living in East Devon are managed exclusively in primary care of whom about 23% maybe eligible for colonoscopic surveillance. We devised an outreach programme, whereby we invited primary care physicians to enrol these patients in a colonoscopic surveillance programme. Methods In December 2017, we contacted 37 general practices, where 161 patients with UC who were eligible for surveillance had been identified. Each practice was sent a letter explaining the goals of the project, a link to the National Institute for Healthcare and Clinical Excellence (NICE) guidance for CRC surveillance in IBD patients and patient information booklets. We informed the practices of their eligible patients and asked them to refer patients for secondary care IBD consults if appropriate. We included an outcome form that captured whether the patient was referred, was deemed inappropriate for surveillance, had surveillance elsewhere, had declined surveillance, or was no longer registered at the practice. Results Sixty-five percent of practices (24/37) responded and we received responses for 57 of 161 (35%) potentially eligible patients. Thirty-five (61%) patients were referred to our IBD service; 7 (12%) patients declined surveillance; 7 (12%) patients were deemed by their GP to be unfit for surveillance and 5 (10%) were no longer registered at the identified GP practice; 2 (4%) had surveillance arranged elsewhere and 1 (2%) patient had died. Amongst the 35 patients referred to secondary care; 22 (63%) underwent surveillance colonoscopy, 12 (34%) declined surveillance after discussion or did not attend their booked appointments and one is awaiting colonoscopy. Half of patients who had a colonoscopy had active inflammation. We diagnosed one CRC He was an elderly man with a locally invasive signet ring caecal tumour, without distant metastases, who went onto to have a curative right hemicolectomy without complication. Conclusion Patients with longstanding IBD are frequently managed exclusively in primary care and maybe overlooked for colonoscopic CRC surveillance. There is a need to implement processes to facilitate identification and recall of patients eligible for surveillance across primary and secondary care.

Diagnosis of Neurologic Disorders

2012 ◽  
Author(s):  
Brian A. Crum ◽  
Eduardo E. Benarroch ◽  
Robert D. Brown
Keyword(s):  
Primary Care ◽  
Differential Diagnosis ◽  
Primary Care Physicians ◽  
Cerebrovascular Disorders ◽  
Diagnostic Testing ◽  
The United States ◽  
Clinical Findings ◽  
Neurologic Disease ◽  
Neurologic Disorder ◽  
Neurologic Disorders

Primary care physicians need a good working knowledge of common and emergency neurologic disorders since they are often encountered in general clinical practice (about 10% of patients of primary care physicians in the United States have neurologic disorders, and about 25% of inpatients have a neurologic disorder as a primary or secondary problem). In the aging population, cerebrovascular disorders, dementias, and Parkinson disease are becoming more prevalent. Understanding a patient with neurologic disease depends on localizing the problem on the basis of the medical history and examination findings, considering a differential diagnosis, and correlating the clinical findings with abnormalities found on appropriate diagnostic testing.

scholarly journals From Screening to Therapy: Anti-HCV Screening and Linkage to Care in a Network of General Practitioners and a Private Gastroenterology Practice

Pathogens ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1570
Author(s):  
David Petroff ◽  
Olaf Bätz ◽  
Katrin Jedrysiak ◽  
Anja Lüllau ◽  
Jan Kramer ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Linkage To Care ◽  
Drop Out ◽  
Hcv Rna ◽  
Care Practices ◽  
Hcv Screening ◽  
Primary Care Practices

(1) Background: Low rates of hepatitis C virus (HCV) diagnosis and sub-optimal linkage to care constitute barriers toward eliminating the infection. In 2012/2013, we showed that HCV screening in primary care detects unknown cases. However, hepatitis C patients may not receive further diagnostics and therapy because they drop out during the referral pathway to secondary care. Thus, we used an existing network of primary care physicians and a practice of gastroenterology to investigate the pathway from screening to therapy. (2) Methods: HCV screening was prospectively included in a routine check-up of primary care physicians who cooperated regularly with a private gastroenterology practice. Anti-HCV-positive patients were referred for further specialized diagnostics and treatment if indicated. (3) Results: Seventeen primary care practices screened 1875 patients. Twelve individuals were anti-HCV-positive (0.6%), six of them reported previous antiviral HCV therapy, and one untreated patient was HCV-RNA-positive (0.05% of the population). None of the 12 anti-HCV-positive cases showed up at the private gastroenterology practice. Further clinical details of the pathway from screening to therapy could not be analyzed. (4) Conclusions: The linkage between primary and secondary care appears to be problematic in the HCV setting even among cooperating partners, but robust conclusions require larger datasets.

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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