Abstract
BackgroundLower use of endoscopies and urgent referrals for suspected cancer has been linked to poorer outcomes for patients with cancer; it is important to examine potential predictors of variable use.AimTo examine the associations between general practice measures of patient experience and practice use of endoscopies or urgent referrals for suspected cancer.Design and settingCross-sectional ecological analysis in English general practices.MethodData were taken from the GP Patient Survey and the Cancer Services Public Health Profiles. After adjustment for practice population characteristics, practice-level associations were examined between the use of endoscopy and urgent referrals for suspected cancer, and the ability to book an appointment (used as proxy for ease of access), the ability to see a preferred doctor (used as proxy for relational continuity), and doctor/nurse communication skills.ResultsTaking into account practice scores for the ability to book an appointment, practices rated higher for the proxy measure of relational continuity used urgent referrals and endoscopies less often (for example, 30% lower urgent referral and 15% lower gastroscopy rates between practices in the 90th/10th centiles, respectively). In contrast, practices rated higher for doctor communication skills used urgent referrals and endoscopies more often (for example, 26% higher urgent referral and 17% higher gastroscopy rates between practices in the 90th/10th centiles, respectively). Patients with cancer in practices that were rated higher for doctor communication skills were less likely to be diagnosed as emergencies (1.7% lower between practices in the 90th than in the 10th centile).ConclusionPractices where patients rated doctor communication highly were more likely to investigate and refer patients urgently but, in contrast, practices where patients could see their preferred doctor more readily were less likely to do so. This article discusses the possible implications of these findings for clinical practice.
Highlights
Achieving accurate and timely diagnosis represents an important challenge for contemporary healthcare systems.[1]
Cancer diagnosis often begins in primary care and involves decisions about investigations and referrals
Systematic underuse of investigations or referrals contributes to longer diagnostic intervals in patients with cancer, and has been linked to poorer cancer survival.[8,9,10]
Summary
Achieving accurate and timely diagnosis represents an important challenge for contemporary healthcare systems.[1] In primary care, deciding appropriately whether a patient should be investigated or referred can be important for their outcome. Such decisions are traditionally seen as the doctor’s personal responsibility, but the influence of contextual factors is increasingly recognised.[2,3]. Diagnostic delays occur in many conditions,[4,5] cancer represents a useful disease model to study diagnostic delay.[6,7] Cancer diagnosis often begins in primary care and involves decisions about investigations and referrals. Lower use of endoscopies and urgent referrals for suspected cancer has been linked to poorer outcomes for patients with cancer; it is important to examine potential predictors of variable use
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
