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Communicating accuracy of tests to general practitioners: a controlled study.

ABSTRACT: OBJECTIVE:To assess the extent to which different forms of summarising diagnostic test information influence general practitioners' ability to estimate disease probabilities. DESIGN:Controlled questionnaire study. SETTING:Three Swiss conferences in continuous medical education. PARTICIPANTS:263 general practitioners. INTERVENTION:Questionnaire with multiple choice questions about terms of test accuracy and a clinical vignette with the results of a diagnostic test described in three different ways (test result only, test result plus test sensitivity and specificity, test result plus the positive likelihood ratio presented in plain language). MAIN OUTCOME MEASURES:Doctors' knowledge and application of terms of test accuracy and estimation of disease probability in the clinical vignette. RESULTS:The correct definitions for sensitivity and predictive value were chosen by 76% and 61% of the doctors respectively, but only 22% chose the correct answer for the post-test probability of a positive screening test. In the clinical vignette doctors given the test result only overestimated its diagnostic value (median attributed likelihood ratio (aLR)=9.0, against 2.54 reported in the literature). Providing the scan's sensitivity and specificity reduced the overestimation (median aLR=6.0) but to a lesser extent than simple wording of the likelihood ratio (median aLR=3.0). CONCLUSION:Most general practitioners recognised the correct definitions for sensitivity and positive predictive value but did not apply them correctly. Conveying test accuracy information in simple, non-technical language improved their ability to estimate disease probabilities accurately.

SUBMITTER: Steurer J

PROVIDER: S-EPMC100792 | biostudies-literature | 2002 Apr

REPOSITORIES: biostudies-literature

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Communicating accuracy of tests to general practitioners: a controlled study.

Steurer Johann J Fischer Joachim E JE Bachmann Lucas M LM Koller Michael M ter Riet Gerben G

BMJ (Clinical research ed.) 20020401 7341

<h4>Objective</h4>To assess the extent to which different forms of summarising diagnostic test information influence general practitioners' ability to estimate disease probabilities.<h4>Design</h4>Controlled questionnaire study.<h4>Setting</h4>Three Swiss conferences in continuous medical education.<h4>Participants</h4>263 general practitioners.<h4>Intervention</h4>Questionnaire with multiple choice questions about terms of test accuracy and a clinical vignette with the results of a diagnostic t ...[more]

PMID: 11934776

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Project description:BackgroundChina has more ascertained cases of diabetes than any other country. Much of the care of people with type 2 diabetes (T2DM) in China is managed by GPs and this will increase with the implementation of health care reforms aimed at strengthening China's primary health care system. Diabetes care requires effective communication between physicians and patients, yet little is known about this area in China. We aimed to explore the experiences of Chinese GPs in communicating with diabetes patients and how this may relate to communication skills training.MethodsFocus groups with Chinese GPs were undertaken. Purposive sampling was used to recruit 15 GPs from Guangzhou city in China. All data were audio-recorded and transcribed. A thematic analysis using the Framework Method was applied to code the data and identify themes.ResultsSeven males and 8 females from 12 general practices attended 4 focus groups with a mean age of 37.6 years and 7.5 years' work experience. Four major themes were identified: diversity in diabetic patients, communication with patients, patient-doctor relationship, and communication skills training. GPs reported facing a wide variety of diabetes patients in their daily practice. They believed insufficient knowledge and misunderstanding of diabetes was common among patients. They highlighted several challenges in communicating with diabetes patients, such as insufficient consultation time, poor communication regarding blood glucose monitoring and misunderstanding the risk of complications. They used terms such as "blind spot" or "not on the same channel" to describe gaps in their patients' understanding of diabetes and its management, and cited this as a cause of ineffective patient-doctor communication. Mutual understanding of diabetes was perceived to be an important factor towards building positive patient-doctor relationships. Although GPs believed communication skills training was necessary, they reported rarely received this.ConclusionsChinese GPs reported facing challenges in communicating with diabetes patients. Some of these were perceived as being due to the patients themselves, others were attributed to system constraints, and some were seen as related to a lack of clinician training. The study identified key issues for the development of primary care-based management of diabetes in China, and for developing appropriate communication skills training programs for the primary care workforce.

Project description:BACKGROUND:Recent developments have made screening tests for foetal abnormalities available earlier in pregnancy and women have a range of testing options accessible to them. It is now recommended that all women, regardless of their age, are provided with information on prenatal screening tests. General Practitioners (GPs) are often the first health professionals a woman consults in pregnancy. As such, GPs are well positioned to inform women of the increasing range of prenatal screening tests available. The aim of this study was to explore GPs experience of informing women of prenatal genetic screening tests for foetal abnormality. METHODS:A qualitative study consisting of four focus groups was conducted in metropolitan and rural Victoria, Australia. A discussion guide was used and the audio-taped transcripts were independently coded by two researchers using thematic analysis. Multiple coders and analysts and informant feedback were employed to reduce the potential for researcher bias and increase the validity of the findings. RESULTS:Six themes were identified and classified as 'intrinsic' if they occurred within the context of the consultation or 'extrinsic' if they consisted of elements that impacted on the GP beyond the scope of the consultation. The three intrinsic themes were the way GPs explained the limitations of screening, the extent to which GPs provided information selectively and the time pressures at play. The three extrinsic factors were GPs' attitudes and values towards screening, the conflict they experienced in offering screening information and the sense of powerlessness within the screening test process and the health care system generally. Extrinsic themes reveal GPs' attitudes and values to screening and to disability, as well as raising questions about the fundamental premise of testing. CONCLUSION:The increasing availability and utilisation of screening tests, in particular first trimester tests, has expanded GPs' role in facilitating women's informed decision-making. Recognition of the importance of providing this complex information warrants longer consultations to respond to the time pressures that GPs experience. Understanding the intrinsic and extrinsic factors that impact on GPs may serve to shape educational resources to be more appropriate, relevant and supportive.

Project description:BACKGROUND:Although death certificates (DCs) provide valuable health information which may help to guide local health policies and priorities, there is little information concerning their validity in Thailand. First-year general practitioners (GPs) have a major role in DC completion, especially in provincial general hospitals. The aim of this study was to evaluate the accuracy and factors influencing the accuracy of DCs completed by first-year GPs in Thailand, compared with the cause of death (COD) derived from medical records by experts. METHODS:This retrospective study was conducted at 14 provincial general hospitals in Thailand during the June 2011 to May 2012 study period. Medical records and DCs completed by first-year GPs who graduated from 16 Thai medical schools were sampled. The cause of death recorded on the DCs was compared with the medical conditions and histories derived from patient medical records. A cross-sectional survey of the 210 GPs who completed the DCs reviewed in this study was also conducted. Respondent GPs' demographic characteristics, factors associated with COD, and COD coding system were evaluated. RESULTS:Five hundred and sixty-three medical records and corresponding DCs were included. Of those, 36.9% of DCs were found to be correct. Common mistakes included incorrect sequence of events leading to death (32.4%), and mode of death use (26.2%). Of the 210 GPs, 155 questionnaires were completed and returned. The mean time spent on recording COD and completing DCs in the medical school curriculum was 2.1?±?0.9 h and only 27.7% of participants had experience in completing DCs by themselves during medical school. Mean medical school GPA was significantly higher in the correctly completed DC GPs group than in the incorrectly completed DC GPs group (3.3?±?0.4 vs. 3.2?±?0.3; p?=?0.03). However, no significant difference was found for other factors associated with COD between groups. CONCLUSIONS:This is the first study documenting gaps and disparities in DC accuracy, and factors influencing completion of DCs among first-year GPs in Thailand, based on a clinical assessment of medical records. GPs made errors on 63.1% of DCs. This finding suggests that proven education, system-related support, and additional training interventions specific to DC completion are required.

Project description:The 2015 NICE guidelines for suspected cancer recommend that English General Practitioners have direct access to diagnostic tests to investigate symptoms of cancer that do not meet the criteria for urgent referral. We aimed to identify the proportion of GPs in England with direct access to these tests.We recruited 533 English GPs through a national clinical research network to complete an online survey about direct access to laboratory, radiology, and endoscopy tests in the three months leading up to the release of the 2015 NICE guidance. If they had direct access to a diagnostic test, GPs were asked about the time necessary to arrange a test and receive a report. Results are reported by NHS sub-region and, adjusting for sampling, for England as a whole.Almost all GPs reported direct access to x-ray and laboratory investigations except faecal occult blood testing (54%, 95% CI 49-59%) and urine protein electrophoresis (89%, 95% CI 84-92%). Fewer GPs had direct access to CT scans (54%, 95% CI 49-59%) or endoscopy (colonoscopy 32%, 95% CI 28-37%; gastroscopy 72%, 95% CI 67-77%). There was significant variation in direct access between NHS regions for the majority of imaging tests-for example, from 20 to 85% to MRI. Apart from x-ray, very few GPs (1-22%) could access radiology and endoscopy within the timescales recommended by NICE. The modal request to test time was 2-4 weeks for routine radiology and 4-6 weeks for routine endoscopy with results taking another 1-2 weeks.At the time that the 2015 NICE guideline was released, local investment was required to not only provide direct access but also reduce the interval between request and test and speed up reporting. Further research using our data as a benchmark is now required to identify whether local improvements in direct access have been achieved in response to the NICE targets. If alternative approaches to test access are to be proposed they must be piloted comprehensively and underpinned by robust effectiveness data.

Project description:We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout. A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap®. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children. We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9-5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15-3.16), working in a suburban area (5.23, 2.18-12.58), and having more than 28 appointments per day (1.95, 1.19-3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93-2.59, p = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02-1.67 and 1.86, 1.34-2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51-0.83; 0.66, 0.48-0.92; and 0.42, 95%CI 0.23-0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13-0.47), as did group practice for intermediate level of burnout (0.71, 0.51-0.96). GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.

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Communicating accuracy of tests to general practitioners: a controlled study.

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Communicating accuracy of tests to general practitioners: a controlled study.

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