scholarly journals Primary care system factors and clinical decision-making in patients that could have lung cancer: A vignette study in five balkan region countries

2021 ◽  
Vol 61 (1) ◽  
pp. 40-47
Author(s):  
Davorina Petek ◽  
Radost Assenova ◽  
Gergana Foreva ◽  
Svjetlana Gašparović Babić ◽  
Marija Petek Šter ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Fast Track ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Direct Access ◽  
Primary Care System ◽  
Advanced Imaging ◽  
Balkan Region ◽  
System Factors

Abstract Introduction Lung cancer is the leading cause of cancer death, with wide variations in national survival rates. This study compares primary care system factors and primary care practitioners’ (PCPs’) clinical decision-making for a vignette of a patient that could have lung cancer in five Balkan region countries (Slovenia, Croatia, Bulgaria, Greece, Romania). Methods PCPs participated in an online questionnaire that asked for demographic data, practice characteristics, and information on health system factors. Participants were also asked to make clinical decisions in a vignette of a patient with possible lung cancer. Results The survey was completed by 475 PCPs. There were significant national differences in PCPs’ direct access to investigations, particularly to advanced imaging. PCPs from Bulgaria, Greece, and Romania were more likely to organise relevant investigations. The highest specialist referral rates were in Bulgaria and Romania. PCPs in Bulgaria were less likely to have access to clinical guidelines, and PCPs from Slovenia and Croatia were more likely to have access to a cancer fast-track specialist appointment system. The PCPs’ country had a significant effect on their likelihood of investigating or referring the patient. Conclusions There are large differences between Balkan region countries in PCPs’ levels of direct access to investigations. When faced with a vignette of a patient with the possibility of having lung cancer, their investigation and referral rates vary considerably. To reduce diagnostic delay in lung cancer, direct PCP access to advanced imaging, availability of relevant clinical guidelines, and fast-track referral systems are needed.

The value of a consultant physiotherapist within a primary care musculoskeletal interface service: part of the spinal multidisciplinary team

2021 ◽  
Vol 28 (1) ◽  
pp. 1-10
Author(s):  
Michelle L Angus ◽  
Victoria Dickens ◽  
Naveed Yasin ◽  
James Greenwood ◽  
Irfan Siddique
Keyword(s):  
Primary Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tertiary Referral Centre ◽  
Allied Health Professionals ◽  
Convenience Sample ◽  
Surgical Services ◽  
Pain Pathway ◽  
The Uk ◽  
Case Based

Background/aims The national low back pain pathway in the UK suggests practitioners managing patients with spinal pathology should be specifically trained to do so and have the ability to link with tertiary spinal services when required. The aim of this study was to ensure referrals through to a tertiary spinal surgical centre are appropriate and patients get the correct advice early in their management pathway. Methods A retrospective review of 700 cases were discussed at a spinal case-based discussion meeting in a primary care interface service, compared to services without this model. A convenience sample of cases were analysed with the consultant physiotherapist and those referred from other allied health professionals into the tertiary spinal surgical centre. Case-based team discussion took place before every referral into the tertiary spinal service, with spinal surgical discussion where required. Results Patients referred from other interface services were more likely to require further work-up such as investigations, or be discharged from clinic on their first attendance than those who had been through the case-based discussion. Conclusions A consultant physiotherapist working as part of the spinal team of a tertiary referral centre can help advanced practitioners with their clinical decision making to help prevent unnecessary referrals to spinal surgical services.

scholarly journals Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e039674 ◽  
Author(s):  
Veronique Verhoeven ◽  
Giannoula Tsakitzidis ◽  
Hilde Philips ◽  
Paul Van Royen
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Decision Making ◽  
Core Competencies ◽  
Well Being ◽  
Clinical Decision ◽  
Framework Analysis ◽  
Profound Impact ◽  
The Core ◽  
Qualitative Interview Study

ObjectivesThe current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline.Design, setting, participantsWe performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis.ResultsChanges in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak—as well as the measures taken to control it—will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves.ConclusionsThe current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.

scholarly journals Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making

BMC Cancer ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
S. Mokhles ◽  
J. J. M. E. Nuyttens ◽  
M. de Mol ◽  
J. G. J. V. Aerts ◽  
A. P. W. M. Maat ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Small Cell Lung Cancer ◽  
Clinical Decision Making ◽  
Early Stage ◽  
Clinical Decision ◽  
Small Cell ◽  
Small Cell Lung ◽  
Selection Of

scholarly journals OVERVIEW: THE VA GERIATRIC SCHOLARS PROGRAM FOR PRIMARY CARE WORKFORCE DEVELOPMENT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S765-S766
Author(s):  
Josea Kramer ◽  
Joe Douglas ◽  
Shawn Clarke ◽  
Luis Melendez
Keyword(s):  
Primary Care ◽  
Workforce Development ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Potentially Inappropriate Medications ◽  
Primary Care Workforce ◽  
Core Components ◽  
Intensive Course ◽  
The Impact ◽  
Inappropriate Medications

Abstract The VA has invested in developing the skills of its primary care workforce through the longitudinal Geriatric Scholars Program. The program consists of core components --- intensive course in geriatrics, intensive workshop in quality improvement (QI) and initiation of a micro QI projects in the Scholar’s clinic; electives allow learners to tailor the program to self-identified gaps in knowledge, skills and competencies. The program has demonstrated direct impacts of continuing education through a workforce development process that enhances skills and competencies at a pace and selection that meets clinicians’ self-identified gaps in training. Now in its 11th year, the program has been shown to increase career satisfaction and job retention, standardize provider behaviors, improve clinical decision-making and reduce dispensing of potentially inappropriate medications. This symposium further explores the impact of the program on individual clinicians and on clinical teams.

Extracts from The Cochrane Library: Antibiotics for acute maxillary sinusitis

2008 ◽  
Vol 139 (4) ◽  
pp. 486-489 ◽  
Author(s):  
Martin J. Burton ◽  
Ronald B. Kuppersmith ◽  
Richard M. Rosenfeld
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Primary Care Setting ◽  
Maxillary Sinusitis ◽  
Cochrane Review ◽  
Clinical Decision ◽  
Neck Surgery ◽  
Cochrane Library ◽  
The Cochrane Library

The “Cochrane Corner” is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology–head and neck surgery, with invited commentary to highlight implications for clinical decision making. This installment features a Cochrane Review entitled “Antibiotics for acute maxillary sinusitis,” which concludes a small treatment effect in patients with uncomplicated acute sinusitis in a primary care setting with symptoms for more than seven days.

scholarly journals Evaluation of a faecal calprotectin care pathway for use in primary care

2016 ◽  
Vol 17 (05) ◽  
pp. 428-436 ◽  
Author(s):  
James Turvill ◽  
Shaun O’Connell ◽  
Abigail Brooks ◽  
Karen Bradley-Wood ◽  
James Laing ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Decision Making ◽  
Diagnostic Yield ◽  
Care Pathway ◽  
Gastrointestinal Symptoms ◽  
Clinical Decision ◽  
Traffic Light ◽  
Faecal Calprotectin ◽  
Predictive Values ◽  
Light System

BackgroundNational Institute for Health and Care Excellence have recommended faecal calprotectin (FC) testing as an option in adults with lower gastrointestinal symptoms for whom specialist investigations are being considered, if cancer is not suspected and it is used to support a diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome. York Hospital and Vale of York Clinical Commissioning Group have developed an evidence-based care pathway to support this recommendation for use in primary care. It incorporates a higher FC cut-off value, a ‘traffic light’ system for risk and a clinical management pathway.ObjectivesTo evaluate this care pathway.MethodsThe care pathway was introduced into five primary care practices for a period of six months and the clinical outcomes of patients were evaluated. Negative and positive predictive values (NPV and PPV) were calculated. GP feedback of the care pathway was obtained by means of a web-based survey. Comparator gastroenterology activity in a neighbouring trust was obtained.ResultsThe care pathway for FC in primary care had a 97% NPV and a 40% PPV. This was better than GP clinical judgement alone and doubled the PPV compared with the standard FC cut-off (<50 mcg/g), without affecting the NPV. In total, 89% of patients with IBD had an FC>250 mcg/g and were diagnosed by ‘straight to test’ colonoscopy within three weeks. The care pathway was considered helpful by GPs and delivered a higher diagnostic yield after secondary care referral (21%) than the conventional comparator pathway (5%).ConclusionsA care pathway for the use of FC that incorporates a higher cut-off value, a ‘traffic light’ system for risk and supports clinical decision making can be achieved safely and effectively. It maintains the balance between a high NPV and an acceptable PPV. A modified care pathway for the use of FC in primary care is proposed.

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