The time-efficiency principle: time as the key diagnostic strategy in primary care

Irving, Greg; Holden, John

doi:10.1093/fampra/cmt007

Cited by 25 publications

(27 citation statements)

References 18 publications

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“…GPs rely on blood test results over clinical presentation while 40% of patients with early RA might be rheumatoid factor negative (24). The challenge in general practice with a low incidence of early RA is to use assessment techniques that are useful for detection (25). Similar to other qualitative studies, GPs' uncertainty in identifying clinical characteristics was observed, mainly due to the mild and slowly progressive symptoms that are variable and often nonspecific (17,26).…”

Section: Comparison With Existing Literaturementioning

confidence: 92%

A general practice perspective on early rheumatoid arthritis management: A qualitative study from Flanders

Meyfroidt

Stevens

Lepeleire

et al. 2015

European Journal of General Practice

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Section: Comparison With Existing Literaturementioning

confidence: 92%

A general practice perspective on early rheumatoid arthritis management: A qualitative study from Flanders

Meyfroidt

Stevens

Lepeleire

et al. 2015

European Journal of General Practice

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“…In some patients, adequate diagnosis requires time for symptoms to evolve. 123 Finally, the presentation of cancer might be obscured by factors that hamper timely diagnosis, such as comorbidity. Existing respiratory disease can prolong the diagnosis of lung cancer, 11 and a high burden of psychiatric or psychosocial comorbidity is associated with delayed diagnosis of colorectal cancer.…”

Section: The Diagnostic Processmentioning

confidence: 99%

The expanding role of primary care in cancer control

Rubin

Berendsen

Crawford

et al. 2015

The Lancet Oncology

448

450

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The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise-from epidemiologists, psychologists, policy makers, and cancer specialists-has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to eff ect change are outlined. The strengths of primary care-its continuous, coordinated, and comprehensive care for individuals and families-are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.

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“…The timeefficiency principle is considered a core diagnostic strategy in low-prevalence settings, and safely as well as efficiently reduces the number of patients who need to be formally tested to make a correct or specific diagnosis for a given person. 26,27 In dealing with diagnostic uncertainty, all GPs screened their patients for certain red flags and some of the GPs applied the familiarity heuristic. The aforementioned red flags largely corresponded with warning signs for secondary headache mentioned in guidelines.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%