Abstract
BackgroundDetection of cancer in general practice is challenging because symptoms are diverse. Even so-called alarm symptoms have low positive predictive values of cancer. Nevertheless, appropriate referral is crucial. As 85% of cancer patients initiate their cancer diagnostic pathway in general practice, a Continuing Medical Education meeting (CME-M) in early cancer diagnosis was launched in Denmark in 2012. We aimed to investigate the effect of the CME-M on the primary care interval, patient contacts with general practice and use of urgent cancer referrals.MethodsA before-after study was conducted in the Central Denmark Region included 396 general practices, which were assigned to one of eight geographical clusters. Practices were invited to participate in the CME-M with three-week intervals between clusters. Based on register data, we calculated urgent referral rates and patient contacts with general practice before referral. Information about primary care intervals was collected by requesting general practitioners to complete a one-page form for each urgent referral during an 8-month period around the time of the CME-Ms. CME-M practices were compared with non-participating reference practices by analysing before-after differences.ResultsForty percent of all practices participated in the CME-M. There was a statistically significant reduction in the number of total contacts with general practice from urgently referred patients in the month preceding the referral and an increase in the proportion of patients who waited 14 days or more in general practice from the reported date of symptom presentation to the referral date from before to after the CME-M in the CME-M group compared to the reference group.ConclusionsWe found a reduced number of total patient contacts with general practice within the month preceding an urgent referral and an increase in the reported primary care intervals of urgently referred patients in the CME-M group. The trend towards higher urgent referral rates and longer primary care intervals may suggest raised awareness of unspecific cancer symptoms, which could cause the GP to register an earlier date of first symptom presentation. The standardised CME-M may contribute to optimising the timing and the use of urgent cancer referral.Trial registrationNCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014
Highlights
Detection of cancer in general practice is challenging because symptoms are diverse
Compared to the reference practices, the Continuing Medical Education meeting (CME-M) practices were more often partnership practices, the General practitioner (GP) were slightly younger and more often female, the practice population size per GP was lower, the practice population consisted of fewer male and slightly less deprived patients (Tables 1 and 2)
The patients used for calculation of the primary care interval were included by 139 CME-M practices and 199 reference practices (Table 3)
Summary
Detection of cancer in general practice is challenging because symptoms are diverse. Even so-called alarm symptoms have low positive predictive values of cancer. We aimed to investigate the effect of the CME-M on the primary care interval, patient contacts with general practice and use of urgent cancer referrals. The ability among general practitioners (GPs) to interpret and respond to symptoms plays a pivotal role in cancer detection as 85% of all cancer patients initiate their diagnostic pathway in general practice [3, 4]. Danish cancer patients have increased visits in general practice already six months before the diagnosis [14], and one in four waits for more than 20 days in general practice until referral [4, 15].
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