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Responsibility for follow-up during the diagnostic process in primary care: a secondary analysis of International Cancer Benchmarking Partnership data.
University of Oxford, UK.
University of Oxford, UK.
University of Oxford, UK.
Aarhus University, Denmark.
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2018 (English)In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 68, no 670, p. e323-e332Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained.

AIM: To explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions.

DESIGN AND SETTING: A secondary analysis of survey data from the International Cancer Benchmarking Partnership.

METHOD: The authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK estimates were compared with non-UK ones. Free-text responses were analysed to contextualise quantitative findings using a modified grounded theory approach.

RESULTS: PCPs varied in their retention of responsibility for follow-up from 19% to 97% across jurisdictions and area of follow-up. Test reconciliation was inadequate in most jurisdictions. Significantly fewer UK PCPs retained responsibility for test result communication (73% versus 85%, P = 0.04) and non-attender follow-up (78% versus 93%, P<0.01) compared with non-UK PCPs. PCPs have developed bespoke, inconsistent solutions to follow-up. In cases of greatest concern, 'double safety netting' is described, where both patient and PCP retain responsibility.

CONCLUSION: The degree to which PCPs retain responsibility for follow-up is dependent on their level of concern about the patient and their primary care system's properties. Integrated systems to support follow-up are at present underutilised, and research into their development, uptake, and effectiveness seems warranted.

Place, publisher, year, edition, pages
Royal College of General Practitioners , 2018. Vol. 68, no 670, p. e323-e332
Keywords [en]
cancer, diagnosis, diagnostic errors, diagnostic safety, general practice, primary care, safety netting
National Category
Cancer and Oncology
Research subject
Natural Science, Medicine
Identifiers
URN: urn:nbn:se:lnu:diva-81213DOI: 10.3399/bjgp18X695813PubMedID: 29686134OAI: oai:DiVA.org:lnu-81213DiVA, id: diva2:1298074
Available from: 2019-03-21 Created: 2019-03-21 Last updated: 2019-04-12Bibliographically approved

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Thulesius, Hans

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CiteExportLink to record
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Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf