Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study

Abstract

BackgroundDelayed 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.MethodsWe 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.ResultsThe 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.ConclusionsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0530-z) contains supplementary material, which is available to authorized users.

Patient and provider perspectives on reducing risk of harm in primary health care: a qualitative questionnaire study in Sweden

“…We share the experience reported by Tudor et al [21,22] about the difficulty in capturing the patients perspective. However, the choice to develop two separate questionnaires and initiate personal contact with patients enabled us to include the patient perspective as well as the perspective of providers.…”

“…Based on the experiences from Tudor et al [21,22], we developed two separate questionnaires with open-ended questions aiming to explore different perspectives of patients as well as providers. The patient questionnaire was designed to capture the perspective of patients who had experienced diagnostic or medication errors on why the error had occurred, and how they thought similar errors could be prevented.…”

“…In the UK, 113 PHC clinicians were asked via questionnaire to identify problems and solutions to patient safety issues. Poor communication between secondary and primary care was emphasised and standardised discharged summaries were suggested [21,22]. In addition, general practitioner (GP) perspectives on patient safety incidents have been explored using critical incident technique interviews of 30 Irish GPs in which diagnostic and medication errors were the most described, and breakdown in communication was seen as a common contributory factor [23].…”

Application of electrochemical aptasensors in detection of cancer biomarkers

“…Annually, millions of cancer cases are found in the world. At the early stages, the diagnosis of cancerous cells are limited and complicated [12][13][14][15] ; One of the main problems in the cancer treatment is the lack of a suitable method for early diagnosis 16,17 . The big challenge associated with various cancers is the delayed diagnosis and the occurrence of metastasis 18,19 .…”

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“…3 In another study, multiple symptoms or co-morbidities masking the real problem was the third most common clinician-identified problem leading to delayed diagnosis. 4 Communication problems related to diagnostic testing may account for nearly half of all errors in typical primary care practice. 5 Learning from missed opportunities for diagnosis is essential for improving patient safety.…”