scholarly journals Diagnostic Tests in The Management of Allergic Diseases in Primary Care

2020 ◽  
pp. 141-146
Author(s):  
Merve UYGUNSOY ◽  
Vildan MEVSİM
Keyword(s):  
Primary Care ◽  
Diagnostic Tests ◽  
Allergic Diseases

scholarly journals Overtesting and undertesting in primary care: a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018557 ◽  
Author(s):  
Jack W O’Sullivan ◽  
Ali Albasri ◽  
Brian D Nicholson ◽  
Rafael Perera ◽  
Jeffrey K Aronson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Pulmonary Function ◽  
Diagnostic Test ◽  
Diagnostic Tests ◽  
Meta Analysis ◽  
Pulmonary Function Tests ◽  
Upper Endoscopy ◽  
Eligibility Criteria ◽  
Function Tests

BackgroundHealth systems are currently subject to unprecedented financial strains. Inappropriate test use wastes finite health resources (overuse) and delays diagnoses and treatment (underuse). As most patient care is provided in primary care, it represents an ideal setting to mitigate waste.ObjectiveTo identify overuse and underuse of diagnostic tests in primary care.DesignSystematic review and meta-analysis.Data sources and eligibility criteriaWe searched MEDLINE and Embase from January 1999 to October 2017 for studies that measured the inappropriateness of any diagnostic test (measured against a national or international guideline) ordered for adult patients in primary care.ResultsWe included 357 171 patients from 63 studies in 15 countries. We extracted 103 measures of inappropriateness (41 underuse and 62 overuse) from included studies for 47 different diagnostic tests.The overall rate of inappropriate diagnostic test ordering varied substantially (0.2%–100%)%).17 tests were underused >50% of the time. Of these, echocardiography (n=4 measures) was consistently underused (between 54% and 89%, n=4). There was large variation in the rate of inappropriate underuse of pulmonary function tests (38%–78%, n=8).Eleven tests were inappropriately overused >50% of the time. Echocardiography was consistently overused (77%–92%), whereas inappropriate overuse of urinary cultures, upper endoscopy and colonoscopy varied widely, from 36% to 77% (n=3), 10%–54% (n=10) and 8%–52% (n=2), respectively.ConclusionsThere is marked variation in the appropriate use of diagnostic tests in primary care. Specifically, the use of echocardiography (both underuse and overuse) is consistently poor. There is substantial variation in the rate of inappropriate underuse of pulmonary function tests and the overuse of upper endoscopy, urinary cultures and colonoscopy.PROSPERO registration numberCRD42016048832.

scholarly journals Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.

2019 ◽  
Author(s):  
Mohammed Talha Bashir ◽  
Lisa Iversen ◽  
Christopher Burton
Keyword(s):  
Primary Care ◽  
Clinical Features ◽  
Diagnostic Tests ◽  
Case Control Study ◽  
Case Control ◽  
Electronic Records ◽  
Large Joint ◽  
Axial Pain ◽  
Nested Case Control ◽  
Control Study

Abstract Background Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS.Methods Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 100 adults with a first diagnosis of AS between 1994 and 2010. Controls were matched for age, sex and GP practice: (a) 400 randomly selected adults (b) 236 adults whose records contained codes indicating spinal conditions or symptoms. We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis.Results Several new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 3.7, 95% CI 1.8 to 7.5) and the co-occurrence of axial pain with either large joint symptoms (OR 2.7, 95% CI 1.1 to 6.3) or tendon symptoms within the same year (OR 3.6, 95% CI 1.3 to 10.3). Coded episodes of axial pain increased steadily over the three years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis.Conclusions We identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.

scholarly journals Utilisation of primary care before a childhood cancer diagnosis: do socioeconomic factors matter?: A Danish nationwide population-based matched cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e023569 ◽  
Author(s):  
Christina Friis Abrahamsen ◽  
Jette Møller Ahrensberg ◽  
Peter Vedsted
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Childhood Cancer ◽  
Socioeconomic Factors ◽  
Cancer Diagnosis ◽  
Low Income ◽  
Diagnostic Tests ◽  
Population Based ◽  
Matched Cohort ◽  
Frequent Use

ObjectivesEarly diagnosis of childhood cancer is critical. Nevertheless, little is known about the potential role of inequality. This study aims to describe the use of primary care 2 years before a childhood cancer diagnosis and to investigate whether socioeconomic factors influence the use of consultations and diagnostic tests in primary care.DesignA national population-based matched cohort study.Setting and participantsThis study uses observational data from four Danish nationwide registers. All children aged 0–15 diagnosed with cancer during 2008–2015 were included (n=1386). Each case was matched based on gender and age with 10 references (n=13 860).Primary and secondary outcome measuresThe primary outcome was additional rates for consultations and for invoiced diagnostic tests for children with cancer according to parental socioeconomic factors. Furthermore, we estimated the association between socioeconomic factors and frequent use of consultations, defined as at least four consultations, and the odds of receiving a diagnostic test within 3 months of diagnosis.ResultsChildren with cancer from families with high income had 1.46 (95% CI 1.23 to 1.69) additional consultations 3 months before diagnosis, whereas children from families with low income had 1.85 (95% CI 1.60 to 2.11) additional consultations. The highest odds of frequent use of consultations was observed among children from low-income families (OR: 1.94, 95% CI 1.24 to 3.03). A higher odds of receiving an invoiced diagnostic test was seen for children from families with mid-educational level (OR: 1.46, 95% CI 1.09 to 1.95).ConclusionWe found a socioeconomic gradient in the use of general practice before a childhood cancer diagnosis. This suggests that social inequalities exist in the pattern of healthcare utilisation in general practice.

scholarly journals A Multinational European Study of Patient Preferences for Novel Diagnostics to Manage Antimicrobial Resistance

2019 ◽  
Vol 18 (1) ◽  
pp. 69-79 ◽  
Author(s):  
David J. Mott ◽  
Grace Hampson ◽  
Martin J. Llewelyn ◽  
Jorge Mestre-Ferrandiz ◽  
Michael M. Hopkins
Keyword(s):  
Primary Care ◽  
Antimicrobial Resistance ◽  
The Netherlands ◽  
Patient Preferences ◽  
Diagnostic Tests ◽  
Stated Preference ◽  
Antibiotic Use ◽  
European Countries ◽  
Trade Offs ◽  
Few Data

Abstract Background Novel diagnostics are needed to manage antimicrobial resistance (AMR). Patient preferences are important in determining whether diagnostic tests are successful in practice, but there are few data describing the test attributes which matter most to patients. We elicited patients’ preferences for attributes of diagnostic tests that could be used to reduce unnecessary antibiotic use in primary care across seven European countries. Methods We used an online stated preference survey, including a discrete choice experiment (DCE). The DCE explored how patients make trade-offs between three key attributes of diagnostic tests: the speed that results were available, confidence in the test results, and how convenient it is to take the test. Individuals were eligible to complete the survey if they had taken antibiotics within the last 2 years and were resident in Germany, Italy, Spain, France, Greece, the Netherlands or the United Kingdom (UK). Results In total, 988 respondents completed the survey. The DCE responses illustrated that speed was the least important attribute in most countries. Responses from Germany and the Netherlands indicated that confidence was most important in these countries. Responses from the UK, France, Spain and Italy showed convenience as the most important attribute in these countries. Two attributes, confidence and convenience, were jointly favoured by respondents in Greece. Conclusion Patients in different European countries do not have the same preferences for the attributes of diagnostic tests to manage AMR in primary care. Failure to account for such differences during test development could reduce test uptake, result in continued overuse of antibiotics, and hamper marketisation.

Managed Care and the Expanding Scope of Primary Care Physicians' Duties: A Proposal to Redefine Explicitly the Standard of Care

1998 ◽  
Vol 26 (2) ◽  
pp. 100-112 ◽  
Author(s):  
Bernard Friedland
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Managed Care ◽  
Health Care System ◽  
Diagnostic Tests ◽  
Primary Care Physicians ◽  
Standard Of Care ◽  
Therapeutic Interventions ◽  
Utilization Review ◽  
Payment Methods

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see more patients per unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so.

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