The future of diagnosis in general practice

Hamilton, William

doi:10.3399/bjgp20x710777

Cited by 11 publications

(12 citation statements)

References 9 publications

(8 reference statements)

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“…Task changing is seen in many countries (such as Denmark, Norway, Sweden and the UK) that have introduced cancer fast-track systems for diagnosing cancer that work well if the symptoms and signs of patients meet the fast-track criteria. Centralised diagnosis procedures or specialised diagnosis services that target many diagnoses simultaneously, called Rapid Diagnostic Centres in the United Kingdom [ 34 ] and diagnostic centres in Denmark [ 8 ] and Sweden, serve patients who do not meet the fast-track criteria.…”

Section: Resultsmentioning

confidence: 99%

Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective

Thulesius

Sandén

Petek

et al. 2021

Scandinavian Journal of Primary Health Care

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Objective To explore how cancer could be diagnosed in a more timely way. Design Grounded theory analysis of primary care physicians’ free text survey responses to: ‘How do you think the speed of diagnosis of cancer in primary care could be improved?’. Secondary analysis of primary care physician interviews, survey responses, literature. Setting Primary care in 20 European Örenäs Research Group countries. Subjects Primary care physicians: 1352 survey respondents (2013-2016), 20 Spanish and 7 Swedish interviewees (2015–2019). Main outcome measures Conceptual explanation of how to improve timeliness of cancer diagnosis. Results Pluralistic task shifting is a grounded theory of a composite strategy. It includes task sharing – among nurses, physicians, nurse assistants, secretaries, and patients – and changing tasks with cancer screening when appropriate or cancer fast-tracks to accelerate cancer case finding. A pluralistic dialogue culture of comprehensive collaboration and task redistribution is required for effective pluralistic task shifting. Pluralistic task shifting relies on cognitive task shifting, which includes learning more about slow analytic reasoning and fast automatic thinking initiated by pattern recognition; and digital task shifting, which by use of eHealth and telemedicine bridges time and place and improves power symmetry between patients, caregivers, and clinicians. Financial task shifting that involves cost tracking followed by reallocation of funds is necessary for the restructuring and retraining required for successful pluralistic task shifting. A timely diagnosis reduces expensive investigations and waiting times. Also, late-stage cancers are costlier to treat than early-stage cancers. Timing is central to cancer diagnosis: not too early to avoid overdiagnosis, and never too late. Conclusions We present pluralistic task shifting as a conceptual summary of strategies needed to optimise the timeliness of cancer diagnosis. Key points Cancer diagnosis is under-researched in primary care, especially theoretically. Thus, inspired by classic grounded theory, we analysed and conceptualised the field: Pluralistic task shifting is a conceptual explanation of how the timeliness of cancer diagnosis could be improved, with data derived mostly from primary care physicians. This includes task sharing and changing tasks including screening and cancer fast-tracks to accelerate cancer case finding, and requires c...

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Section: Resultsmentioning

confidence: 99%

Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective

Thulesius

Sandén

Petek

et al. 2021

Scandinavian Journal of Primary Health Care

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“…Tennis elbow has been reported to be four times more common in the fourth decades of life [7] . The incidence rate has been shown to be similar in both sexes [8] . However, the choice of treatment options for this condition is even more controversial.…”

Section: Introductionmentioning

confidence: 91%

Comparative study between corticosteroid injection and ultrasound therapy in treatment of lateral epicondylitis of humerus

Sarkar¹,

Mukhopadhyay²,

Chaturvedi³

2023

Int. J. Orthop. Sci.

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Tennis elbow or lateral epicondylitis is a condition in which the outer part of the elbow becomes sore and tender. The forearm muscles and tendons become damaged from overuse -repeating the same strenuous motions again and again. This leads to inflammation, pain and tenderness on the outside of the elbow. Any activity, including playing tennis, which involves the repetitive use of the extensor muscles of the forearm can cause acute or chronic tendinitis of the tendinous insertion of these muscles at the lateral epicondyle of the elbow. It is a common pathology of both athletes and non-athletes affecting 1 to 3% population at large. Tennis elbow is seldom observed in subjects under the age of 25 years and black people are apparently affected less frequently than the whites. Tennis elbow has been reported to be four times more common in the fourth decades of life. Currently available conservative treatment methods include acupuncture, ultrasound therapy, steroid injection, counter force bracing, cross friction massaging. Some of these treatment modalities have no scientific basis. The most successful non operative treatment consists of avoidance of overuse counterforce bracing to relieve the insertion of extensor tendons, steroid injection into the affected area and stretching exercises.

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“…In the BHCI, patients are given 30day prescriptions and are expected to attend clinic visits every 30 days. Failure to attend follow-up visits is associated with adverse health outcomes [10,11]. Effective strategies to reduce visit non-attendance and thereby retain treated patients in care are urgently needed to improve hypertension control in Bangladesh, as well as globally.…”

Section: Introductionmentioning

confidence: 99%

Text Messaging to Improve Retention in Hypertension Care in Bangladesh

Gupta,

Jubayer,

Akhtar

et al. 2024

Preprint

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Visit non-attendance is a common barrier to hypertension control in low and middle-income countries (LMICs). We aimed to evaluate the effectiveness of mobile text messaging in improving visit attendance among patients with hypertension in primary care facilities in Bangladesh. A randomized A/B testing study was conducted with two patient groups: (1) patients regularly attending visits (regular patients) and (2) patients overdue for follow-up visits (overdue patients). Regular patients were randomized into three groups: a cascade of three text reminders, a single text reminder, or no text reminder. Overdue patients were randomized into two groups: a single text reminder or no text reminder. 20,072 regular patients and 12,708 overdue patients were enrolled. Among regular patients, visit attendance was significantly higher in the cascade reminder group and the single reminder group compared to the no reminder group (78.2% and 76.6% vs. 74.8%, p < 0.001 and 0.027, respectively). Among overdue patients, the single reminder group had a 5.8% higher visit attendance compared to the no reminder group (26.5% vs. 20.7%, p < 0.001). The results remained consistent in multivariable analysis; adjusted prevalence ratio (PR) was 1.04 (95% CI 1.02–1.06) for the cascade reminder group and 1.02 (95% CI 1.00-1.05) for the single reminder group among regular patients. The adjusted PR for the single reminder group vs. the no reminder group among overdue patients was 1.23 (95% CI 1.15–1.33). Text message reminders are an effective strategy for improving retention of patients in hypertension treatment in LMICs, especially for patients overdue to care.

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The future of diagnosis in general practice

Cited by 11 publications

References 9 publications

Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective

Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective

Comparative study between corticosteroid injection and ultrasound therapy in treatment of lateral epicondylitis of humerus

Text Messaging to Improve Retention in Hypertension Care in Bangladesh

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