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Br J Gen Pract ; 68(670): e323-e332, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29686134

RESUMEN

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.


Asunto(s)
Benchmarking , Continuidad de la Atención al Paciente/organización & administración , Neoplasias/terapia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud , Actitud del Personal de Salud , Recolección de Datos , Estudios de Seguimiento , Encuestas de Atención de la Salud , Investigación sobre Servicios de Salud , Humanos , Neoplasias/rehabilitación , Responsabilidad Social
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