The Diagnostic Value of the Patient’s Reason for Encounter for Diagnosing Cancer in Primary Care

Abstract Background Cough is a relevant reason for encounter in primary care. For evidence-based decision making, general practitioners need setting-specific knowledge about prevalences, pre-test probabilities, and prognosis. Accordingly, we performed a systematic review of symptom-evaluating studies evaluating cough as reason for encounter in primary care. Methods We conducted a search in MEDLINE and EMBASE. Eligibility criteria and methodological quality were assessed independently by two reviewers. We extracted data on prevalence, aetiologies and prognosis, and estimated the variation across studies. If justifiable in terms of heterogeneity, we performed a meta-analysis. Results We identified 21 eligible studies on prevalence, 12 on aetiology, and four on prognosis. Prevalence/incidence estimates were 3.8–4.2%/12.5% (Western primary care) and 10.3–13.8%/6.3–6.5% in Africa, Asia and South America. In Western countries the underlying diagnoses for acute cough or cough of all durations were respiratory tract infections (73–91.9%), influenza (6–15.2%), asthma (3.2–15%), laryngitis/tracheitis (3.6–9%), pneumonia (4.0–4.2%), COPD (0.5–3.3%), heart failure (0.3%), and suspected malignancy (0.2–1.8%). Median time for recovery was 9 to 11 days. Complete recovery was reported by 40.2- 67% of patients after two weeks, and by 79% after four weeks. About 21.1–35% of patients re-consulted; 0–1.3% of acute cough patients were hospitalized, none died. Evidence is missing concerning subacute and chronic cough. Conclusion Prevalences and incidences of cough are high and show regional variation. Acute cough, mainly caused by respiratory tract infections, is usually self-limiting (supporting a “wait-and-see” strategy). We have no setting-specific evidence to support current guideline recommendations concerning subacute or chronic cough in Western primary care. Our study presents epidemiological data under non non-pandemic conditions. It will be interesting to compare these data to future research results of the post-pandemic era.

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Diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis

British Journal of General Practice ◽

10.3399/bjgp15x686941 ◽

2015 ◽

Vol 65 (639) ◽

pp. e677-e691 ◽

Cited By ~ 7

Author(s):

Margaret P Astin ◽

Tanimola Martins ◽

Nicky Welton ◽

Richard D Neal ◽

Peter W Rose ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Meta Analysis ◽

Diagnostic Value

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Is it possible to register the ideas, concerns and expectations behind the reason for encounter as a means of classifying patient preferences with ICPC-2?

Primary Health Care Research & Development ◽

10.1017/s1463423617000391 ◽

2017 ◽

Vol 19 (01) ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Diego Schrans ◽

Pauline Boeckxstaens ◽

An De Sutter ◽

Sara Willems ◽

Dirk Avonts ◽

...

Keyword(s):

Primary Care ◽

Patient Preferences ◽

Time Frame ◽

Specific Procedure ◽

Reason For Encounter ◽

Related Information ◽

Almost All ◽

Danger To Others ◽

Do So

BackgroundFamily practice aims to recognize the health problems and needs expressed by the person rather than only focusing on the disease. Documenting person-related information will facilitate both the understanding and delivery of person-focused care.AimTo explore if the patients’ ideas, concerns and expectations (ICE) behind the reason for encounter (RFE) can be coded with the International Classification of Primary Care, version 2 (ICPC-2) and what kinds of codes are missing to be able to do so.MethodsIn total, 613 consultations were observed, and patients’ expressions of ICE were narratively recorded. These descriptions were consequently translated to ICPC codes by two researchers. Descriptions that could not be translated were qualitatively analysed in order to identify gaps in ICPC-2.ResultsIn all, 613 consultations yielded 672 ICE expressions. Within the 123 that could not be coded with ICPC-2, eight categories could be defined: concern about the duration/time frame; concern about the evolution/severity; concern of being contagious or a danger to others; patient has no concern, but others do; expects a confirmation of something; expects a solution for the symptoms without specification of what it should be; expects a specific procedure; and expects that something is not done.DiscussionAlthough many ICE can be registered with ICPC-2, adding eight new categories would capture almost all ICE.

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Reliability and validity of ICPC-2-R encoding by medical students

Revista Brasileira de Medicina de Família e Comunidade ◽

10.5712/rbmfc13(40)1655 ◽

2018 ◽

Vol 13 (40) ◽

pp. 1-6

Author(s):

Leonardo Ferreira Fontenelle ◽

Álvaro Damiani Zamprogno ◽

André Filipe Lucchi Rodrigues ◽

Lorena Camillato Sirtoli ◽

Natália Josiele Cerqueira Checon ◽

...

Keyword(s):

Primary Care ◽

Medical Students ◽

Reliability And Validity ◽

International Classification ◽

Free Text ◽

Reason For Encounter ◽

Community Physician ◽

In The Beginning ◽

Reasons For Encounter

Objective: To estimate how reliably and validly can medical students encode reasons for encounter and diagnoses using the International Classification of Primary Care, revised 2nd edition (ICPC-2-R). Methods: For every encounter they supervised during an entire semester, three family and community physician teachers entered the reasons for encounter and diagnoses in free text into a form. Two of four medical students and one teacher encoded each reason for encounter or diagnosis using the ICPC-2-R. In the beginning of the study, two three-hour workshops were held, until the teachers were confident the students were ready for the encoding. After all the reasons for encounter and the diagnoses had been independently encoded, the seven encoders resolved the definitive codes by consensus. We defined reliability as agreement between students and validity as their agreement with the definitive codes, and used Gwet’s AC1 to estimate this agreement. Results: After exclusion of encounters encoded before the last workshop, the sample consisted of 149 consecutive encounters, comprising 262 reasons for encounter and 226 diagnoses. The encoding had moderate to substantial reliability (AC1, 0.805; 95% CI, 0.767–0.843) and substantial validity (AC1, 0.864; 95% CI, 0.833–0.891). Conclusion: Medical students can encode reasons for encounter and diagnoses with the ICPC-2-R if they are adequately trained.

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Heart-type fatty acid binding protein (H-FABP) in patients in an emergency department setting, suspected of acute coronary syndrome: Optimal cut-off point, diagnostic value and future opportunities in primary care

European Journal of General Practice ◽

10.3109/13814788.2015.1013934 ◽

2015 ◽

Vol 21 (3) ◽

pp. 156-163 ◽

Cited By ~ 12

Author(s):

Robert TA Willemsen ◽

Evie van Severen ◽

Pieter M Vandervoort ◽

Lars Grieten ◽

Frank Buntinx ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Acute Coronary Syndrome ◽

Fatty Acid ◽

Fatty Acid Binding Protein ◽

Diagnostic Value ◽

Fatty Acid Binding ◽

Coronary Syndrome ◽

Acid Binding Protein ◽

Emergency Department Setting

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Validity of urges to smoke measures in predicting smoking relapse during treatment in primary care

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-021-00259-3 ◽

2021 ◽

Vol 31 (1) ◽

Author(s):

Daniel Kotz ◽

Carolien van Rossem ◽

Wolfgang Viechtbauer ◽

Mark Spigt ◽

Onno C. P. van Schayck

Keyword(s):

Primary Care ◽

Smoking Cessation ◽

Diagnostic Value ◽

Predictive Values ◽

Smoking Cessation Treatment ◽

Cut Point ◽

Point Increase ◽

Cessation Treatment ◽

Measured Time

AbstractIn the context of smoking cessation treatment in primary care, identifying patients at the highest risk of relapse is relevant. We explored data from a primary care trial to assess the validity of two simple urges to smoke questions in predicting long-term relapse and their diagnostic value. Of 295 patients who received behavioural support and varenicline, 180 were abstinent at week 9. In this subgroup, we measured time spent with urges to smoke (TSU) and strength of urges to smoke (SUT; both scales 1 to 6 = highest). We used separate regression models with TSU or SUT as predictor and relapse from week 9–26 or week 9–52 as an outcome. We also calculated the sensitivity (SP), specificity and positive predictive values (PPV) of TSU and SUT in correctly identifying patients who relapsed at follow-up. The adjusted odds ratios (aOR) for predicting relapse from week 9–26 were 1.74 per point increase (95% CI = 1.05–2.89) for TSU and 1.59 (95% CI = 1.11–2.28) for SUT. The aORs for predicting relapse from week 9–52 were 2.41 (95% CI = 1.33–4.37) and 1.71 (95% CI = 1.14–2.56), respectively. Applying a cut-point of ≥3 on TSU resulted in SP = 97.1 and PPV = 70.0 in week 9–26, and SP = 98.8 and PPV = 90.0 in week 9–52. Applying a cut-point of ≥4 on SUT resulted in SP = 99.0 and PPV = 85.7 in week 9–26, and SP = 98.8 and PPV = 85.7 in week 9–52. Both TSU and SUT were valid predictors of long-term relapse in patients under smoking cessation treatment in primary care. These simple questions may be useful to implement in primary care.Trial registration: Dutch Trial Register (NTR3067).

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Primary care direct access cerebral imaging in Lothian, Scotland: a 5-year retrospective analysis of referrals, assessment of utility of referral guidelines, and determination of incidence of abnormalities

British Journal of General Practice ◽

10.3399/bjgp18x697481 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697481

Author(s):

Karolis Zienius ◽

Chak Ip ◽

Mio Ozawa ◽

Robin Grant ◽

Yoav Ben-Shlomo ◽

...

Keyword(s):

Primary Care ◽

Brain Tumour ◽

Diagnostic Value ◽

Direct Access ◽

Intracranial Tumour ◽

Cerebral Imaging ◽

Yellow Flag ◽

Increased Risk ◽

Red Flag

BackgroundDirect Access Cerebral Imaging (DACI) from Primary Care has been recommended by NICE for patients with symptoms suspicious of cancer.AimWe analysed the predictive value of the NICE (2005) and Kernick referral guidance for suspicion of brain tumour in a real-world settingMethodDACI referrals from Lothian-based GPs (31/3/2010 to 1/4/2015) were categorised according to the symptom classifications of NICE 2005 and Kernick referral guidelines. Radiological findings were grouped into 1) normal/non-significant-incidental, 2) abnormal-significant, 3) intracranial tumour.ResultsIn total, 3257 head scans were performed, and after exclusions, 2938 records were analysed. Mean age was 55.6 (SD 18.56), 1748 (60%) females. Forty-two scans (1.43%) revealed significant intracranial tumours, including 17 (40%) metastases, 10 primary intracerebral tumours (24%), 8 pituitary (19%), 7 meningioma (17%). Non-significant incidental findings were observed on 571 (19%) scans, of which 175 (6%) correlated with symptoms. Based on NICE (2005) guidelines, 39% referrals were for ‘symptoms related to the CNS’, 16% for ‘Headache of raised ICP’, 18% for ‘Sub-acute deficits’ and 27% for ‘Unexplained headache’. Kernick guidelines classified 39% referrals red-flag, 25% orange-flag, and 36% yellow-flag symptoms. NICE ‘Symptoms related to CNS’ (OR 5.21, 95% CI = 1.81 to 14.9; PPV 2.9, 95% CI 2.0 to 4.0) and Kernick’s red-flag symptoms (OR 5.73, 95% CI =2.21 to 14.84; PPV 2.8, 95% CI = 1.9 to 3.9) were the only features to have significantly increased risk of brain tumour.ConclusionReferral guidelines confirm the urgency for rapid access head imaging for symptoms ‘highly suspicious’ of brain tumour. We are now assessing diagnostic value of different symptom complexes for intracranial tumour including headache-plus.

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