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. 2018 May;68(670):e323-e332.
doi: 10.3399/bjgp18X695813. Epub 2018 Apr 23.

Responsibility for follow-up during the diagnostic process in primary care: a secondary analysis of International Cancer Benchmarking Partnership data

Brian D Nicholson  1 , Clare R Goyder  1 , Clare R Bankhead  1 , Berit S Toftegaard  2 , Peter W Rose  1 , Hans Thulesius  3 , Peter Vedsted  2 , Rafael Perera  1
Affiliations

Responsibility for follow-up during the diagnostic process in primary care: a secondary analysis of International Cancer Benchmarking Partnership data

Brian D Nicholson et al. Br J Gen Pract. 2018 May.

Abstract

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.

Keywords: cancer; diagnosis; diagnostic errors; diagnostic safety; general practice; primary care; safety netting.

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References

    1. Singh H, Giardina TD, Meyer AN, et al. Types and origins of diagnostic errors in primary care settings. JAMA Intern Med. 2013;173(6):418–425. - PMC - PubMed
    1. Willis BH, Beebee H, Lasserson DS. Philosophy of science and the diagnostic process. Fam Pract. 2013;30(5):501–505. - PubMed
    1. Almond SC, Summerton N. Diagnosis in general practice. Test of time. BMJ. 2009;338:b1878. - PubMed
    1. Singh H, Schiff GD, Graber ML, et al. The global burden of diagnostic errors in primary care. BMJ Qual Saf. 2017;26(6):484–494. - PMC - PubMed
    1. National Academies of Sciences, Engineering, and Medicine . Improving diagnosis in health care. Washington, DC: National Academies Press; 2015. https://doi.org/10.17226/21794 (accessed 26 Mar 2018) - DOI

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