چکیده (انگلیسی):

Background:Delayed diagnosis in primary care is a common, harmful and costly patient safety incident. Its
measurement and monitoring are underdeveloped and underutilised. We created and implemented a novel
approach to identify problems leading to and solutions for delayed diagnosis in primary care.
Methods:We developed a novel priority-setting method for patient safety problems and solutions called
PRIORITIZE. We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three
main problems and solutions relating to delayed diagnosis in primary care. 113 clinicians submitted their
suggestions which were thematically grouped and synthesized into a composite list of 33 distinct problems and 27
solutions. A random group of 75 clinicians from the initial cohort scored these and an overall ranking was derived.
The agreement between the clinicians’ scores was presented using the Average Expert Agreement.
Results:The top ranked problems were poor communication between secondary and primary care and the inverse
care law, i.e. a mismatch between patients’ medical needs and healthcare supply. The highest ranked solutions
included: a more rigorous system of communicating abnormal results of investigations to patients, direct hotlines
to specialists for GPs to discuss patient problems and better training of primary care clinicians in relevant areas. A
priority highlighted throughout the findings is a need to improve communication between clinicians as well as
with patients. The highest ranked suggestions had the highest consensus between experts.
Conclusions:The novel method we have developed is highly feasible, informative and scalable, and merits wider
exploration with a view of becoming part of a routine pro-active and preventative system for patient safety
assessment. Clinicians proposed a range of concrete suggestions with an emphasis on improving communication
among clinicians and with patients and better GP training. In their view, delayed diagnosis can be largely
prevented with interventions requiring relatively minor investment. Rankings of identified problems and solutions
can serve as an aid to policy makers and commissioners of care in prioritization of scarce healthcare resources.