Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview study
Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview study
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DOI：
10.1186/s12875-019-0941-8
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发表时间：
2019-04-26
影响因子：
2.9
通讯作者：
Hayward, Gail N.
中科院分区：
文献类型：
--
作者：
McKelvie, Sara;Moore, Abigail;Hayward, Gail N.
背景：老年人的严重感染与计划外住院和高死亡率有关。识别严重感染的存在并做出准确的诊断是全科医学面临的重要挑战。本研究旨在探讨英国全科医生在诊断老年患者严重感染时面临的问题。方法：使用半结构化访谈进行定性研究。有目的地从英国各地抽取了 27 家诊所的 28 名全科医生，以在全科医生的角色、经验和执业人群方面实现最大程度的差异。访谈首先要求参与者描述最近或难忘的案例，在这些案例中，他们评估了疑似严重感染的老年患者。主题指南中的其他问题用于进一步探讨挑战。使用修改后的框架方法对访谈记录进行编码和分析。结果：参与的全科医生认为诊断老年人的严重感染具有挑战性，并且诊断通常是不确定的。影响因素包括患者的复杂性、不典型的表现以及由于缺乏连续性而缺乏对患者的了解。患者评估的每个阶段都存在诊断挑战。评分系统主要用作沟通工具。有时使用调查来解决诊断的不确定性，但结果的可用性和速度限制了其实际使用。与患者及其家人共享清晰的安全网计划有助于全科医生应对持续的不确定性。结论：在初级保健中对患有严重感染的老年人进行评估时，诊断方面存在挑战。支持全科医生提供连续性护理可能会提高人们的认识，并且开发用于社区环境的护理点测试可能会减少诊断的不确定性。
Background: Serious infections in older people are associated with unplanned hospital admissions and high mortality. Recognising the presence of a serious infection and making an accurate diagnosis are important challenges for General Practice. This study aimed to explore the issues UK GPs face when diagnosing serious infections in older patients.Methods: Qualitative study using semi-structured interviews. 28 GPs from 27 practices were purposively sampled from across the UK to achieve maximum variation in terms of GP role, experience and practice population. Interviews began by asking participants to describe recent or memorable cases where they had assessed older patients with suspected serious infections. Additional questions from the topic guide were used to explore the challenges further. Interview transcripts were coded and analysed using a modified framework approach.Results: Diagnosing serious infection in older adults was perceived to be challenging by participating GPs and the diagnosis was often uncertain. Contributing factors included patient complexity, atypical presentations, as well as a lack of knowledge of patients due to a loss in continuity. Diagnostic challenges were present at each stage of the patient assessment. Scoring systems were mainly used as communication tools. Investigations were sometimes used to resolve diagnostic uncertainty, but availability and speed of result limited their practical use. Clear safety-net plans shared with patients and their families helped GPs manage ongoing uncertainty.Conclusions: Diagnostic challenges are present throughout the assessment of an older adult with a serious infection in primary care. Supporting GPs to provide continuity of care may improve the recognition and developing point of care testing for use in community settings may reduce diagnostic uncertainty.