P6 Work-related respiratory symptoms in the UK; Do primary care physicians miss diagnostic opportunities in occupational asthma?

Recently, bronchial asthma is considered as a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is one of the most common chronic respiratory diseases in primary care. Patients with certain respiratory symptoms seek for medical aid initially in primary care physicians, such as therapeutists, general practitioners, and family physicians, who can suspect and diagnose chronic respiratory diseases such as bronchial asthma, chronic obstructive pulmonary disease (COPD), allergic rhinitis, etc. Currently, untimely diagnosis of asthma and late initiation of anti-inflammatory treatment are widespread, mainly due to insufficient knowledge of primary care physicians on diagnostic criteria and therapeutic standards for asthma. Feasible and convenient algorithms for asthma diagnosis and treatment in primary care were developed by experts of Russian Respiratory Society and Russian Association of Allergologists and Clinical Immunologists. A therapeutic algorithm for asthma treatment in primary care institutions uses an approach considering symptom severity both in patients with newly diagnosed and previously treated for asthma. Diagnostic tools, such as a questionnaire for asthma diagnosis and an algorithm for differential diagnosis between asthma and COPD are mainly intended to facilitate diagnosis of chronic respiratory disease, particularly bronchial asthma, by a primary care physician and to improve the healthcare quality for these patients.

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Pay-for-performance and primary care physicians: lessons from the UK Quality and Outcomes Framework for local incentive schemes

Journal of the Royal Society of Medicine ◽

10.1177/0141076815576701 ◽

2015 ◽

Vol 108 (3) ◽

pp. 80-82 ◽

Cited By ~ 6

Author(s):

Paramjit Gill ◽

Rachel Foskett-Tharby ◽

Nick Hex

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Pay For Performance ◽

Incentive Schemes ◽

Quality And Outcomes ◽

The Uk ◽

Quality And Outcomes Framework

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A Primary Care Perspective on Gout

The Open Urology & Nephrology Journal ◽

10.2174/1874303x01609010027 ◽

2016 ◽

Vol 9 (1) ◽

pp. 27-34

Author(s):

Eva Rimler ◽

Jennifer Lom ◽

Jason Higdon ◽

Dominique Cosco ◽

Danielle Jones

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Hospital Admissions ◽

Primary Care Providers ◽

Treat To Target ◽

Care Providers ◽

Work Related ◽

Treat All ◽

Care Costs

Gout causes patients’ significant morbidity, work-related disability, loss of productivity, increased health care costs, and even all-cause hospital admissions. As a result, primary care providers must be armed with the knowledge to properly diagnose and manage gout. While many aspects of care remain the same, some key updates that primary care providers must consider when treating their patients with gout will be discussed. In this perspective we will highlight and discuss acceptable circumstances for empiric treatment, renewed emphasis on treat to target, access to commonly used medications, recommended first line agents, and the role of primary care physicians in gout flare prevention among other topics. These strategies will aid primary care physicians treat all but the most complex cases of gout.

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The success of the Rapid Diagnostic Clinic (RDC) detecting new cancers in patients with non-localizing symptoms.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.303 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 303-303

Author(s):

Jan Sindhar ◽

Sabine Martin ◽

Loay Rahman ◽

Sifan Zheng ◽

Yaseen Mukadam ◽

...

Keyword(s):

Primary Care ◽

Cancer Diagnosis ◽

Primary Care Physicians ◽

Early Stage ◽

Recovery Phase ◽

Referral Criteria ◽

Anti Cancer ◽

Set Up ◽

The Uk

303 Background: Rapid Diagnostic Clinics (RDC) are being set up across the UK allow primary care physicians to refer patients with symptoms concerning for cancer that do not fulfil tumour-specific two week wait urgent referral criteria. Guy’s RDC was established to address the high cancer related mortality in our network. There is little data assessing the effectiveness of RDC models is available in a British population. Methods: We evaluated all patients referred to Guy’s RDC pilot scheme between December 2016-June 2019 (n=1,341) to assess the rate and type of cancer diagnosed and clinical outcomes. Results: Of 1341 patients, 96 cancers were diagnoses (7.2%). Most common were lung (16%), haematological (13%) and colorectal (12%). A third were at early stage (I-II) and 40% received radical treatment. Median time to cancer diagnosis 28 days (IQR 15-47) and treatment 56 days (IQR 32-84). 75% of patients were suitable for anti-cancer treatment: surgery (26%), systemic (24%) and radiotherapy (14%). We plan to present updated data on > 2000 patients referred until June 2020. Overall 6% of patients were diagnosed with pre-malignant conditions. Conclusions: RDCs provide a streamlined pathway for complex vague symptoms patients which are challenging for primary care. The 7% rate of cancer diagnosis exceeds many tumour specific urgent pathways which supports the need for rapid tailored diagnostics. The detection of pre-malignant conditions in 6% allows surveillance and intervention to potentially improve long-term outcomes. RDCs are likely to be pivotal in the cancer recovery phase of the COVID-19 pandemic.

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A primary care team approach to secondary prevention of work-related musculoskeletal disorders: Perspectives from physical therapy

Work ◽

10.3233/wor-205139 ◽

2021 ◽

pp. 1-23

Author(s):

Jonathan Dropkin ◽

Asha Roy ◽

Jaime Szeinuk ◽

Jacqueline Moline ◽

Robert Baker

Keyword(s):

Primary Care ◽

Secondary Prevention ◽

Musculoskeletal Disorders ◽

Primary Care Physicians ◽

Treatment Success ◽

The United States ◽

Care Team ◽

Team Approach ◽

Work Related ◽

Extended Care

BACKGROUND: Among work-related conditions in the United States, musculoskeletal disorders (MSDs) account for about thirty-four percent of work absences. Primary care physicians (PCPs) play an essential role in the management of work-related MSDs; for conditions diagnosed as work-related, up to seventeen percent of cases are PCP managed; within these conditions, up to fifty-nine percent are diagnosed as musculoskeletal. Negative factors in treatment success confronting PCPs include time constraints and unfamiliarity with work-related MSDs. A multidimensional team approach to secondary prevention, where PCPs can leverage the expertise of allied health professionals, might provide a useful alternative to current PCP practices for the treatment of work-related MSDs. OBJECTIVE: Provide the structure of and rationale for an “extended care team” within primary care for the management of work-related MSDs. METHODS: A systematic literature search, combining medical subject headings and keywords, were used to examine eight peer-reviewed literature databases. Gray literature, such as government documents, were also used. RESULTS: An extended care team would likely consist of at least nine stakeholders within primary care. Among these stakeholders, advanced practice orthopedic physical therapists can offer particularly focused guidance to PCPs on the evaluation and treatment of work-related MSDs. CONCLUSIONS: A multidimensional approach has the potential to accelerate access and improve quality of work-related outcomes, while maintaining patient safety.

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S158 Occupational asthma; referral patterns from primary care in the UK

Thorax ◽

10.1136/thx.2010.150953.9 ◽

2010 ◽

Vol 65 (Suppl 4) ◽

pp. A72-A72

Author(s):

J. L. Hoyle ◽

L. Hussey ◽

R. Agius

Keyword(s):

Primary Care ◽

Occupational Asthma ◽

Referral Patterns ◽

The Uk

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Pyromellitic dianhydride (PMDA) may cause occupational asthma

Occupational and Environmental Medicine ◽

10.1136/oemed-2018-105295 ◽

2019 ◽

Vol 76 (3) ◽

pp. 175-177 ◽

Cited By ~ 1

Author(s):

Milene Torp Madsen ◽

Lars Rauff Skadhauge ◽

Anders Daldorph Nielsen ◽

Jesper Baelum ◽

David Lee Sherson

Keyword(s):

Occupational Asthma ◽

Respiratory Symptoms ◽

Working Hours ◽

Risk Identification ◽

Pyromellitic Dianhydride ◽

Respiratory Protection ◽

European Respiratory Society ◽

Work Related ◽

Forced Expiratory Flow ◽

Lactose Powder

IntroductionAnhydrides are widely used as cross-linking agents in epoxy resins and alkyd production, for example, as coatings and adhesives in plastic products. Sensitisation to several anhydrides is known to cause occupational asthma. There are indications that the lesser known pyromellitic dianhydride (PMDA) can cause irritative respiratory symptoms and possibly asthma. We report three cases of workers from a plastic foil manufacturing plant, who developed asthma when exposed to PMDA during specific inhalation challenge (SIC).MethodsSIC was performed over 2 days according to recommendations of European Respiratory Society. Lactose powder was used in control challenges and a mixture of 10% PMDA and 90% lactose powder in active challenges.ResultsAll cases experienced a delayed decrease in forced expiratory flow in 1 s (FEV1) 4–12 hours after active challenge. FEV1 decreased by 19%, 15% and 16%, respectively. After 21 hours, FEV1 decreased by 24% in one worker.DiscussionRespiratory symptoms after working hours may represent delayed work-related asthma. During SIC, the three patients developed lower respiratory symptoms and a delayed decrease in FEV1 which suggest sensitisation. The mechanism of anhydride-related asthma is not well understood. Anhydrides are known irritants and hence an irritative response cannot be excluded. The company improved ventilation and enforced the use of respiratory protection equipment, and finally phased out PMDA. Occupational workplace risk identification may help to identify exposures. SIC can contribute to improving working conditions, by identifying and confirming asthmogens in the environment.

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Diagnostic routes and time intervals for patients with colorectal cancer in 10 international jurisdictions; findings from a cross-sectional study from the International Cancer Benchmarking Partnership (ICBP)

BMJ Open ◽

10.1136/bmjopen-2018-023870 ◽

2018 ◽

Vol 8 (11) ◽

pp. e023870 ◽

Cited By ~ 12

Author(s):

David Weller ◽

Usha Menon ◽

Alina Zalounina Falborg ◽

Henry Jensen ◽

Andriana Barisic ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Primary Care Physicians ◽

Cancer Registries ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Time Intervals ◽

Cross Sectional ◽

Treatment Data ◽

The Uk

ObjectiveInternational differences in colorectal cancer (CRC) survival and stage at diagnosis have been reported previously. They may be linked to differences in time intervals and routes to diagnosis. The International Cancer Benchmarking Partnership Module 4 (ICBP M4) reports the first international comparison of routes to diagnosis for patients with CRC and the time intervals from symptom onset until the start of treatment. Data came from patients in 10 jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia).DesignPatients with CRC were identified via cancer registries. Data on symptomatic and screened patients were collected; questionnaire data from patients’ primary care physicians and specialists, as well as information from treatment records or databases, supplemented patient data from the questionnaires. Routes to diagnosis and the key time intervals were described, as were between-jurisdiction differences in time intervals, using quantile regression.ParticipantsA total of 14 664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses.Primary and secondary outcome measuresInterval lengths in days (primary), reported patient symptoms (secondary).ResultsThe main route to diagnosis for patients was symptomatic presentation and the most commonly reported symptom was ‘bleeding/blood in stool’. The median intervals between jurisdictions ranged from: 21 to 49 days (patient); 0 to 12 days (primary care); 27 to 76 days (diagnostic); and 77 to 168 days (total, from first symptom to treatment start). Including screen-detected cases did not significantly alter the overall results.ConclusionICBP M4 demonstrates important differences in time intervals between 10 jurisdictions internationally. The differences may justify efforts to reduce intervals in some jurisdictions.

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