Associations between diagnostic activity and measures of patient experience in primary care: a cross-sectional ecological study of English general practices
Associations between diagnostic activity and measures of patient experience in primary care: a cross-sectional ecological study of English general practices
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DOI：
10.3399/bjgp17x694097
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发表时间：
2018-01-01
影响因子：
5.9
通讯作者：
Abel, Gary A.
中科院分区：
文献类型：
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作者：
Lyratzopoulos, Georgios;Mendonca, Silvia C.;Abel, Gary A.
背景&段落；&对位;较低的内窥镜检查使用率和疑似癌症的紧急转诊与癌症患者预后较差有关；检查变量使用的潜在预测因素是很重要的。&对位;&对位;Aim & para；&对位;检查患者经验的一般实践措施与内窥镜检查或疑似癌症紧急转诊的实践使用之间的关系。&对位;&对位;设计与设置&参数；&对位;英语全科实践中的横断面生态学分析。&对位;&对位;Method & para；&对位;数据来自全科医生患者调查和癌症服务公共卫生概况。在调整了执业人群特征后，研究了执业水平上内窥镜检查的使用与疑似癌症的紧急转诊之间的关联，以及预约的能力（用于方便获取的代理）、看首选医生的能力（用于关系连续性的代理）和医生/护士沟通技巧。&对位;&对位;结果&段落；&对位;考虑到预约能力的实践得分，在关系连续性的代理测量中，实践得分较高，使用紧急转诊和内窥镜检查的频率较低（例如，在第90 /10百分位数的实践中，紧急转诊率降低30%，胃镜检查率降低15%）。相比之下。在医生沟通技巧方面，急诊转诊和内窥镜检查的使用频率更高（例如，在第90 /10百分位数的实践中，急诊转诊率高出26%，胃镜检查率高出17%）。在医生沟通技巧方面得分较高的诊所中，癌症患者被诊断为急诊的可能性较低（第90百分位的诊所比第10百分位的诊所低1.7%）。&对位;&对位;结论&段落；&对位;患者对医生沟通评价较高的诊所更有可能紧急调查和转诊患者，但相比之下，患者更容易看到自己喜欢的医生的诊所不太可能这样做。本文讨论了这些发现对临床实践可能产生的影响。
Background & para;& para;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.& para;& para;Aim & para;& para;To examine the associations between general practice measures of patient experience and practice use of endoscopies or urgent referrals for suspected cancer.& para;& para;Design and setting & para;& para;Cross-sectional ecological analysis in English general practices.& para;& para;Method & para;& para;Data 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.& para;& para;Results & para;& para;Taking 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).& para;& para;Conclusion & para;& para;Practices 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.