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首页> 外文期刊>BMC Family Practice >Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study
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Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study

机译：临床医生确定的初级保健延误诊断的问题和解决方案：一项优先研究

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Background Delayed diagnosis in primary care is a common, harmful and costly patient safety incident. Its measurement and monitoring are underdeveloped and underutilised. We created and implemented a novel approach to identify problems leading to and solutions for delayed diagnosis in primary care. Methods We developed a novel priority-setting method for patient safety problems and solutions called PRIORITIZE. We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to delayed diagnosis in primary care. 113 clinicians submitted their suggestions which were thematically grouped and synthesized into a composite list of 33 distinct problems and 27 solutions. A random group of 75 clinicians from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the Average Expert Agreement. Results The top ranked problems were poor communication between secondary and primary care and the inverse care law, i.e. a mismatch between patients’ medical needs and healthcare supply. The highest ranked solutions included: a more rigorous system of communicating abnormal results of investigations to patients, direct hotlines to specialists for GPs to discuss patient problems and better training of primary care clinicians in relevant areas. A priority highlighted throughout the findings is a need to improve communication between clinicians as well as with patients. The highest ranked suggestions had the highest consensus between experts. Conclusions The novel method we have developed is highly feasible, informative and scalable, and merits wider exploration with a view of becoming part of a routine pro-active and preventative system for patient safety assessment. Clinicians proposed a range of concrete suggestions with an emphasis on improving communication among clinicians and with patients and better GP training. In their view, delayed diagnosis can be largely prevented with interventions requiring relatively minor investment. Rankings of identified problems and solutions can serve as an aid to policy makers and commissioners of care in prioritization of scarce healthcare resources.
机译：背景技术初级保健中的延迟诊断是常见，有害且代价高昂的患者安全事件。它的测量和监视功能尚不完善，未得到充分利用。我们创建并实施了一种新颖的方法来识别导致初级保健延迟诊断的问题和解决方案。方法我们针对患者安全问题和解决方案开发了一种新颖的优先级设置方法，称为PRIORITIZE。我们通过不限成员名额调查表邀请了500多名伦敦西北区的临床医生，以确定与初级保健延迟诊断有关的三个主要问题和解决方案。 113位临床医生提交了他们的建议，这些建议按照主题进行了分组，并汇总为33个不同问题和27个解决方案的综合清单。最初队列中的75名临床医生组成的随机小组对此进行了评分，并得出了总体排名。临床医生评分之间的协议是使用“平均专家协议”提出的。结果排名最靠前的问题是二级保健和初级保健之间的沟通不畅以及逆保健法，即患者的医疗需求与医疗保健供应不匹配。排名最高的解决方案包括：更加严格的系统，将异常的调查结果传达给患者;将热线电话联系GP的专家，以讨论患者的问题;以及对相关领域的初级保健临床医生进行更好的培训。整个研究结果中强调的优先事项是需要改善临床医生之间以及与患者之间的沟通。排名最高的建议在专家之间达成最高共识。结论我们开发的新方法具有高度的可行性，信息性和可扩展性，值得进行更广泛的探索，以期成为常规的主动和预防性患者安全评估系统的一部分。临床医生提出了一系列具体建议，重点在于改善临床医生与患者之间的沟通以及更好的GP培训。他们认为，只需花费相对少量的干预就可以在很大程度上防止延迟诊断。已确定的问题和解决方案的排名可以帮助决策者和护理专员优先分配稀缺的医疗资源。

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