scholarly journals Routes to Diagnosis for Suspected Sarcoma: The Impact of Symptoms and Clinical Findings on the Diagnostic Process

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Heidi Buvarp Dyrop ◽  
Peter Vedsted ◽  
Mathias Rædkjær ◽  
Akmal Safwat ◽  
Johnny Keller
Keyword(s):  
Primary Care ◽  
Clinical Findings ◽  
Diagnostic Process ◽  
Time Intervals ◽  
Local Hospital ◽  
Doctor Visit ◽  
Presenting Symptoms ◽  
One Year ◽  
The Impact ◽  
Diagnostic Intervals

Background and Objectives. Sarcoma patients often experience delay before diagnosis. We examined the association between presenting symptoms/signs and time intervals for suspected sarcoma patients.Methods. 545 consecutive patients suspected for sarcoma referred over a one-year period were included. Median time intervals in routes to diagnosis were collected from medical records and questionnaires.Results. 102 patients (18.7%) had a sarcoma; 68 (12.5%) had other malignancies. Median interval for the patient (time from first symptom to first doctor visit), primary care, local hospital, sarcoma center, diagnostic, and total interval for sarcoma patients were 77, 17, 29, 17, 65, and 176 days, respectively. Sarcoma patients visited more hospital departments and had longer median primary care (+10 days) and diagnostic intervals (+19 days) than patients with benign conditions. Median primary care (−19 days) and sarcoma center (−4 days) intervals were shorter for patients with a lump versus no lump. Median patient (+40 days), primary care (+12 days), diagnostic (+17 days), and total intervals (+78 days) were longer for patients presenting with pain versus no pain. GP suspicion of malignancy shortened local hospital (−20 days) and total intervals (−104 days).Conclusions. The main part of delay could be attributed to the patient and local hospitals. Length of time intervals was associated with presenting symptoms/signs and GP suspicion.

scholarly journals Impact of the Presenting Symptom on Time Intervals and Diagnostic Routes of Patients with Symptomatic Oral Cancer

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5163
Author(s):  
Pablo Ignacio Varela-Centelles ◽  
Daniel Pérez López ◽  
José Luis López-Cedrún ◽  
Álvaro García-Rozado ◽  
Pablo Castelo Baz ◽  
...  
Keyword(s):  
Primary Care ◽  
Oral Cancer ◽  
Time Interval ◽  
Time Intervals ◽  
Cross Sectional ◽  
Presenting Symptoms ◽  
Relative Contribution ◽  
Dental Practitioners ◽  
Incident Cases ◽  
The Impact

This investigation was aimed at determining the time intervals from the presenting symptoms until the beginning of oral cancer treatment and their relative contribution to the total time, and to assess the impact of the presenting symptom on diagnostic timelines and patient referral routes. A cross-sectional, ambispective study was designed to investigate symptomatic incident cases. The Aarhus statement was used as a conceptual framework. Strategies for minimizing potential recall biases were implemented. A sample of 181 patients was recruited (power: 99.5%; α = 0.05). The patient interval reached 58.2 days (95% CI, 40.3–76.2), which accounted for 74% of the whole prereferral interval and for more than one third of the total time interval. The presenting symptom (trigger for consultation) influenced both the number of primary care consultations and the length of time to diagnosis. General dental practitioners generated longer intervals to diagnosis (p < 0.005) and needed more consultations before referring a patient (RR = 0.76; 95% CI, 0.61–0.93), than general medical practitioners. The current study identifies the patient as the main target for interventions to improve awareness and reinforces the need for increased alertness amongst healthcare professionals about presenting symptoms of oral cancer and to diminish the number of prereferral consultations in order to optimize the primary care interval.

scholarly journals An Effectiveness Trial of STEADI in an Outpatient, Primary Care Practice

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 774-774
Author(s):  
David Rein ◽  
Madeleine Hackney ◽  
Michele Dougherty ◽  
Camille Vaughan ◽  
Laurie Imhof ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Review ◽  
Primary Care Practice ◽  
Controlled Trial ◽  
Care Practice ◽  
Strength Assessment ◽  
Randomized Controlled ◽  
Study Team ◽  
One Year ◽  
The Impact

Abstract The STEADI Options trial uses a randomized, controlled-trial design to assess the effectiveness and cost-effectiveness of the STEADI Initiative . Beginning March, 2020, we will randomize 3,000 adults ≥ 65 years of age at risk for falls seen in an Emory Clinic primary care practice to: (1) full STEADI; (2) a STEADI-derived gait, balance, and strength assessment with physical therapy referrals; (3) a STEADI-derived medication review and management; or (4) usual care. This presentation will discuss decisions made by the study team to facilitate implementation of STEADI including electronically conducting screening prior to the date of encounter, the use of dedicated nursing staff to conduct assessments, implementation of strength, balance, orthostatic hypotension, and vision testing, methods to facilitate medication review, and communication of assessment information to providers. The results from this study will be used to estimate the impact of STEADI on falls, service utilization, and costs over one year.

scholarly journals Barriers and Facilitators to Colorectal Cancer Diagnosis in New Zealand: A Qualitative Study

2020 ◽  
Author(s):  
Tania Blackmore ◽  
Kimberley Norman ◽  
Jacquie Kidd ◽  
Shemana Cassim ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New Zealand ◽  
Help Seeking ◽  
Barriers And Facilitators ◽  
Diagnostic Process ◽  
Interpersonal Competence ◽  
Technical Competence ◽  
Positive Experience ◽  
The Impact ◽  
Diagnostic Intervals

Abstract Background: New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals.Methods: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic).Results: Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family.Conclusions: The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.

scholarly journals Does the Primary Care Experience Influence the Cancer Diagnostic Process?

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Sylvie Provost ◽  
Raynald Pineault ◽  
Pierre Tousignant ◽  
Danièle Roberge ◽  
Dominique Tremblay ◽  
...  
Keyword(s):  
Primary Care ◽  
Metastatic Cancer ◽  
Diagnostic Process ◽  
Process Time ◽  
Care Experience ◽  
Usual Source ◽  
Point Of Entry ◽  
Experience Of Care ◽  
Time To Diagnosis ◽  
The Impact

Objective. To analyze the impact of patients’ experience of care at their usual source of primary care on their choice of point of entry into cancer investigation process, time to diagnosis, and presence of metastatic cancer at time of diagnosis. Method. A questionnaire was administered to 438 patients with cancer (breast, lung, and colorectal) between 2011 and 2013 in four oncology clinics of Quebec (Canada). Multiple regression analyses (logistic and Cox models) were conducted. Results. Among patients with symptoms leading to investigation of cancer (n=307), 47% used their usual source of primary care as the point of entry for investigation. Greater comprehensiveness of care was associated with the decision to use this source as point of entry (OR = 1.25; CI 90% = 1.06–1.46), as well as with shorter times between first symptoms and investigation (HR = 1.11; p=0.05), while greater accessibility was associated with shorter times between investigation and diagnosis (HR = 1.13; p<0.01).  Conclusion. Experience of care at the usual source of primary care has a slight influence on the choice of point of entry for cancer investigation and on time to diagnosis. This influence appears to be more related to patients’ perceptions of the accessibility and comprehensiveness of their usual source of primary care.

scholarly journals Therapeutic itinerary of people with tuberculosis in face with their health needs

2019 ◽  
Vol 23 (3) ◽  
Author(s):  
Aliéren Honório Oliveira ◽  
Antonio Germane Alves Pinto ◽  
Maria do Socorro Vieira Lopes ◽  
Tânia Maria Ribeiro Monteiro de Figueiredo ◽  
Edilma Gomes Rocha Cavalcante
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Qualitative Study ◽  
Health Needs ◽  
Smear Microscopy ◽  
Structured Interviews ◽  
X Ray ◽  
Entrance Door ◽  
One Year ◽  
The Impact

Abstract Objective: To describe the therapeutic itinerary of people with tuberculosis in face of their health needs. Method: Descriptive, qualitative study. Semi-structured interviews were carried out with ten patients. Hermeneutic-dialectic method of analysis and concept of therapeutic itinerary as driver of the analysis. Results: Most had classic symptoms at the beginning, however there was a case with coughing for more than one year. Entrance door, access to diagnosis and treatment were predominant in Primary Care, through smear microscopy and X-ray; patients had to pay for exams. Decentralization of treatment for other services when necessary or by link with the professional. The patient followed the decisions of the professionals and the support of relatives; prejudice regarding the disease was noted. Conclusions and implications for practice: Fragility in disease management, importance of bonding and family. It should be considered the impact of the disease and the need to support patients to ensure continuity of care.

THE IMPACT OF FRAILTY ON POST-ACUTE REHABILITATION OUTCOMES IN OLDER ADULTS

2014 ◽  
pp. 1-4
Author(s):  
R. ROMERO-ORTUNO ◽  
C. TIERNAN ◽  
L. COGAN
Keyword(s):  
Primary Care ◽  
Discharge Rate ◽  
Acute Hospital ◽  
Care Programme ◽  
Rehabilitation Outcomes ◽  
Rehabilitative Care ◽  
Significant Difference ◽  
One Year ◽  
Acute Rehabilitation ◽  
The Impact

We assessed the correlations of the Frailty Instrument for primary care of the Survey of Health,Ageing and Retirement in Europe (SHARE-FI on admission: non-frail, pre-frail, frail) with the outcomes of aShort-term Post-Acute Rehabilitative Care programme (N=172 admissions over one-year period, 95 of whichwere frail). SHARE-FI correlated with age (non-frail: mean 79.2 years; frail: 83.6; P<0.001). Adjusting for age,SHARE-FI correlated with longer length of stay (non-frail: median 30 days; frail: 42; P=0.047), higher rate ofemergency transfer to acute hospital (non-frail: 2.4%; frail: 21.1%; P=0.004), and lower home discharge rate(non-frail: 97.6%; frail: 81.9%; P=0.009). While frailty correlated with more disability on admission anddischarge, there was no statistically significant difference in Barthel Index (BI) improvement across frailtycategories (all groups had median BI improvement of ≥2 points, P=0.247). The post-acute rehabilitation of thefrail is worthwhile but requires more time and access to acute hospital facilities.

scholarly journals Barriers and Facilitators to Colorectal Cancer Diagnosis in New Zealand: A Qualitative Study

2020 ◽  
Author(s):  
Tania Blackmore ◽  
Kimberley Norman ◽  
Jacquie Kidd ◽  
Shemana Cassim ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New Zealand ◽  
Help Seeking ◽  
Barriers And Facilitators ◽  
Diagnostic Process ◽  
Interpersonal Competence ◽  
Technical Competence ◽  
Positive Experience ◽  
The Impact ◽  
Diagnostic Intervals

Abstract Background: New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals. Methods: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic). Results: Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family. Conclusions: The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.

scholarly journals Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit

2017 ◽  
Vol 68 (666) ◽  
pp. e63-e72 ◽  
Author(s):  
Ruth Swann ◽  
Sean McPhail ◽  
Jana Witt ◽  
Brian Shand ◽  
Gary A Abel ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Clinical Audit ◽  
Patient Characteristics ◽  
Diagnostic Process ◽  
Comorbid Condition ◽  
Key Aspects ◽  
New Diagnosis ◽  
Diagnostic Delays ◽  
The Impact

BackgroundContinual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this.AimTo characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit.Design and settingClinical audit of cancer diagnosis in general practices in England.MethodInformation on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management.ResultsData were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15–86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0–27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more.ConclusionThe findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer.

Benzodiazepines and non-benzodiazepine hypnotics – impact of a cluster adopted protocol on primary care prescribing

2019 ◽  
Vol 64 (3) ◽  
pp. 97-102 ◽  
Author(s):  
Christopher J Weatherburn
Keyword(s):  
Primary Care ◽  
Information Service ◽  
Interrupted Time Series ◽  
Defined Daily Dose ◽  
Its Analysis ◽  
Daily Dose ◽  
General Practices ◽  
One Year ◽  
The Impact ◽  
Information Service Division

Background and Aims Reduction of benzodiazepines and non-benzodiazepine hypnotics (BZDs and Z-drugs) prescribing is a priority. Dundee, Scotland, has a total of 25 general practices, split into four clusters. The cluster with the highest recorded prescribing of BZDs and Z-drugs adopted a prescribing protocol that aimed to reduce such prescribing. This paper evaluates the impact of this protocol. Methods Quarterly prescribing data were obtained from Information Service Division, NHS Scotland from Q1 2015/16 to Q4 2017/18. Data were split into four clusters and standardised to Defined Daily Dose (DDDs) per 1000 registered patients. Interrupted time series (ITS) analysis was performed to assess prescribing one year after this protocol was introduced. Results There was a crude reduction in prescribing of BZDs and Z-drugs across all GP practice clusters, but this related to an ongoing downward trend in prescribing. Allowing for this, in the cluster that adopted the protocol, ITS revealed there was no significant reduction attributable to the intervention in prescribing of DDD equivalent doses (−0.4%, 95% CI: −7.2 to 7.6). Conclusions Introduction of a cluster-wide prescribing protocol did not provide significant reduction of prescribing. Although crude figures might suggest an improvement, ITS analysis revealed this not to be the case.

scholarly journals Determinants of referral of women with urinary incontinence to specialist services: a national cohort study using primary care data from the UK

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Ipek Gurol-Urganci ◽  
Rebecca S. Geary ◽  
Jil B. Mamza ◽  
Masao Iwagami ◽  
Dina El-Hamamsy ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Incontinence ◽  
Cohort Study ◽  
Secondary Care ◽  
Referral Rates ◽  
Primary Care Data ◽  
Specialist Services ◽  
One Year ◽  
The Impact ◽  
Minority Ethnic

Abstract Background Female urinary incontinence is underdiagnosed and undertreated in primary care. There is little evidence on factors that determine whether women with urinary incontinence are referred to specialist services. This study aimed to investigate characteristics associated with referrals from primary to specialist secondary care for urinary incontinence. Methods We carried out a cohort study, using primary care data from over 600 general practices contributing to the Clinical Practice Research Datalink (CPRD) in the United Kingdom. We used multi-level logistic regression to estimate adjusted odds ratios (aOR) that reflect the impact of patient and GP practice-level characteristics on referrals to specialist services in secondary care within 30 days of a urinary incontinence diagnosis. All women aged ≥18 years newly diagnosed with urinary incontinence between 1 April 2004 and 31 March 2013 were included. One-year referral was estimated with death as competing event. Results Of the 104,466 included women (median age: 58 years), 28,476 (27.3%) were referred within 30 days. Referral rates decreased with age (aOR 0.34, 95% CI 0.31–0.37, comparing women aged ≥80 with those aged 40–49 years) and was lower among women who were severely obese (aOR 0.84, 95% CI 0.78–0.90), smokers (aOR 0.94, 95% CI 0.90–0.98), women from a minority-ethnic backgrounds (aOR 0.76, 95% CI 0.65–0.89 comparing Asian with white women), women with pelvic organ prolapse (aOR 0.77, 95% CI 0.68–0.87), and women in Scotland (aOR 0.60, 95% CI 0.46–0.78, comparing women in Scotland and England). One-year referral rate was 34.0% and the pattern of associations with patient characteristics was almost the same as for 30-day referrals. Conclusions About one in four women with urinary incontinence were referred to specialist secondary care services within one month after a UI diagnosis and one in three within one year. Referral rates decreased with age which confirms concerns that older women with UI are less likely to receive care according to existing clinical guidelines. Referral rates were also lower in women from minority-ethnic backgrounds. These finding may reflect clinicians’ beliefs about the appropriateness of referral, differences in women’s preferences for treatment, or other factors leading to inequities in referral for urinary incontinence.

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