Dataset Information

Evaluating the scripts and thresholds of general practitioners for diagnosing heart failure in elderly people.

ABSTRACT:

Background

Multiple diagnostic algorithms for heart failure exist. However, it is unclear whether these algorithms are incorporated in the 'scripts' clinicians use in every day practice. Scripts are networks of organised knowledge that are acquired and accumulated during clinical training and are refined with each clinical encounter. This study was conducted to evaluate the scripts and thresholds that GPs use to diagnose heart failure in patients aged 75 years and older.

Methods

The scripts and thresholds of 130 Belgian GPs in training and 63 experienced trainers were compared using an online questionnaire based on the same principles as the script concordance test. Two major cases with an open question and 19 minor cases with closed questions were presented. For the minor cases, all of the respondents were asked to assign a diagnostic power to individual cues. Based on these powers, a diagnostic threshold was calculated for each respondent for the two major cases.

Results

The trainers and trainees used the same scripts to diagnose heart failure in the two major cases. Only ~50 % of the participants used natriuretic peptides in their scripts, although they judged it as the most powerful marker to demonstrate or exclude heart failure. The power that respondents gave to several cues differed significantly according to the context in which these cues were presented. In general, the average exclusive power of different cues was lower than the demonstrative power of the cues. There was no difference in diagnostic threshold between the trainers and trainees.

Conclusion

Young, inexperienced GPs used the same scripts as older, more experienced GPs. In general, technical investigations were less frequently queried, compared to elements of the medical history and the clinical examination. The clinical context had a strong impact on the diagnostic power that was assigned to different factors.

SUBMITTER: Decaluwe K

PROVIDER: S-EPMC4955166 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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Publications

Evaluating the scripts and thresholds of general practitioners for diagnosing heart failure in elderly people.

Decaluwe Klaartje K Degryse Jan J Vaes Bert B

BMC family practice 20160721

<h4>Background</h4>Multiple diagnostic algorithms for heart failure exist. However, it is unclear whether these algorithms are incorporated in the 'scripts' clinicians use in every day practice. Scripts are networks of organised knowledge that are acquired and accumulated during clinical training and are refined with each clinical encounter. This study was conducted to evaluate the scripts and thresholds that GPs use to diagnose heart failure in patients aged 75 years and older.<h4>Methods</h4>T ...[more]

PMID: 27439700

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Project description:BackgroundA number of studies have identified advanced age as a barrier to accessing specialised oncological care. Many factors can influence the care provided for elderly patients after a diagnosis of cancer has been established or is suspected. Only one European study has analysed the decision processes leading general practitioners (GPs) to refer elderly patients with cancer to oncologists. The objectives of the current study are to describe the factors that influence these decisions and to identify the particular factors and GP characteristics that are associated with systematic referral of these patients in South-West France.MethodsThis is a cross-sectional study on a representative sample of GPs in Aquitaine, South-West France. Questionnaire items were selected using a Delphi consensus approach and sent by post. Two logistic regression models were constructed to investigate GPs' decisions to refer these patients.ResultsThe response rate obtained was 30%. Half of the general practitioners reported "always" referring their elderly cancer patients to oncologists. More than 75% reported being influenced by patient-related elements (patient and/or family wishes, comorbid factors, unsuitability of invasive investigations, physical and mental autonomy), by cancer-related elements (severity of symptoms, expected side-effects) and an organisational element (whether the general practitioner was used to collaborating with oncologists). Logistic regression analysis showed that cancer site and organisational difficulties in patient management were significantly associated with the decision to refer elderly patients with early-stage cancer. For advanced stages, oncology training, patient age, organisational difficulties in patient management and stage of cancer were significantly associated with the decision to refer elderly patients.ConclusionsCancer-linked factors and organisational difficulties have been highlighted as influencing the decisions of GPs in the referral of elderly patients to a cancer team. These results highlight the need to implement continuous medical education specific for the management of elderly patients, to better apprehend the nature of these difficulties and to suggest solutions suited to local settings.

Dataset Information

Evaluating the scripts and thresholds of general practitioners for diagnosing heart failure in elderly people.

Background

Methods

Results

Conclusion

Publications

Evaluating the scripts and thresholds of general practitioners for diagnosing heart failure in elderly people.

Similar Datasets

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