Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview study
Abstract 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 f...
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | BMC Family Practice |
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| Online Access: | http://link.springer.com/article/10.1186/s12875-019-0941-8 |
| _version_ | 1828471853271744512 |
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| author | Sara McKelvie Abigail Moore Caroline Croxson Daniel S. Lasserson Gail N. Hayward |
| author_facet | Sara McKelvie Abigail Moore Caroline Croxson Daniel S. Lasserson Gail N. Hayward |
| author_sort | Sara McKelvie |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-11T05:19:57Z |
| format | Article |
| id | doaj.art-2e7bd19f82b049e89bfefc38c092195c |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-12-11T05:19:57Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-2e7bd19f82b049e89bfefc38c092195c2022-12-22T01:19:44ZengBMCBMC Family Practice1471-22962019-04-012011910.1186/s12875-019-0941-8Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview studySara McKelvie0Abigail Moore1Caroline Croxson2Daniel S. Lasserson3Gail N. Hayward4Nuffield Department of Primary Care Health Sciences, University of OxfordNuffield Department of Primary Care Health Sciences, University of OxfordNuffield Department of Primary Care Health Sciences, University of OxfordInstitute of Applied Health Research, University of BirminghamNuffield Department of Primary Care Health Sciences, University of OxfordAbstract 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.http://link.springer.com/article/10.1186/s12875-019-0941-8Clinical decision-makingGeriatricGeneral practitionersInfectionOlder peoplePrimary health care |
| spellingShingle | Sara McKelvie Abigail Moore Caroline Croxson Daniel S. Lasserson Gail N. Hayward Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview study BMC Family Practice Clinical decision-making Geriatric General practitioners Infection Older people Primary health care |
| title | Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview study |
| title_full | Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview study |
| title_fullStr | Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview study |
| title_full_unstemmed | Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview study |
| title_short | Challenges and strategies for general practitioners diagnosing serious infections in older adults: a UK qualitative interview study |
| title_sort | challenges and strategies for general practitioners diagnosing serious infections in older adults a uk qualitative interview study |
| topic | Clinical decision-making Geriatric General practitioners Infection Older people Primary health care |
| url | http://link.springer.com/article/10.1186/s12875-019-0941-8 |
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