Journal
BRITISH JOURNAL OF GENERAL PRACTICE
Volume 68, Issue 670, Pages E323-E332Publisher
ROYAL COLL GENERAL PRACTITIONERS
DOI: 10.3399/bjgp18X695813
Keywords
cancer; diagnosis; diagnostic errors; diagnostic safety; general practice; primary care; safety netting
Categories
Funding
- Cancer Research UK through Early Diagnosis Advisory Group (EDAG) [C50916/A21500]
- Canadian Partnership Against Cancer
- Cancer Care Manitoba
- Cancer Care Ontario
- Cancer Council Victoria
- Cancer Institute New South Wales
- Danish Health and Medicines Authority
- Danish Cancer Society
- Department of Health in England
- Department of Health in Victoria
- Northern Ireland Cancer Registry
- Public Health Agency in Northern Ireland
- Norwegian Directorate of Health
- South Wales Cancer Network
- Swedish Association for Local Authorities and Regions
- Tenovus
- British Columbia Cancer Agency
- Welsh Government
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Background It is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained. Aim To explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions. Design and setting A secondary analysis of survey data from the International Cancer Benchmarking Partnership. Method The authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK estimates were compared with non-UK ones. Free-text responses were analysed to contextualise quantitative findings using a modified grounded theory approach. Results PCPs varied in their retention of responsibility for follow-up from 19% to 97% across jurisdictions and area of follow-up. Test reconciliation was inadequate in most jurisdictions. Significantly fewer UK PCPs retained responsibility for test result communication (73% versus 85%, P = 0.04) and non-attender follow-up (78% versus 93%, P<0.01) compared with non-UK PCPs. PCPs have developed bespoke, inconsistent solutions to follow-up. In cases of greatest concern, 'double safety netting' is described, where both patient and PCP retain responsibility. Conclusion The degree to which PCPs retain responsibility for follow-up is dependent on their level of concern about the patient and their primary care system's properties. Integrated systems to support follow-up are at present underutilised, and research into their development, uptake, and effectiveness seems warranted.
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