Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
Br J Gen Pract. 2018 May;68(670):e323-e332. doi: 10.3399/bjgp18X695813. Epub 2018 Apr 23.
It is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained.
To explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions.
A secondary analysis of survey data from the International Cancer Benchmarking Partnership.
The authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK estimates were compared with non-UK ones. Free-text responses were analysed to contextualise quantitative findings using a modified grounded theory approach.
PCPs varied in their retention of responsibility for follow-up from 19% to 97% across jurisdictions and area of follow-up. Test reconciliation was inadequate in most jurisdictions. Significantly fewer UK PCPs retained responsibility for test result communication (73% versus 85%, = 0.04) and non-attender follow-up (78% versus 93%, <0.01) compared with non-UK PCPs. PCPs have developed bespoke, inconsistent solutions to follow-up. In cases of greatest concern, 'double safety netting' is described, where both patient and PCP retain responsibility.
The degree to which PCPs retain responsibility for follow-up is dependent on their level of concern about the patient and their primary care system's properties. Integrated systems to support follow-up are at present underutilised, and research into their development, uptake, and effectiveness seems warranted.
目前尚不清楚初级保健医生（PCP）应在多大程度上保留随访责任，以确保患者得到监测，直到其症状或体征得到解释。
探讨 11 个国际司法管辖区的 PCP 在多大程度上保留诊断随访的责任。
对国际癌症基准测试伙伴关系的调查数据进行二次分析。
作者计算了 2879 名 PCP 保留对每个随访领域（预约、检验结果和失约者）负责的比例。按每个司法管辖区的样本量对比例进行加权。使用随机效应模型获得汇总估计值，并将英国的估计值与非英国的估计值进行比较。使用修改后的扎根理论方法，对定量发现进行自由文本分析，以了解背景。
在不同的司法管辖区和随访领域，PCP 对随访的保留责任差异很大，从 19%到 97%不等。在大多数司法管辖区，检验结果的核对都不充分。与非英国的 PCP 相比，英国的 PCP 保留对检验结果沟通（73%对 85%， = 0.04）和失约者随访（78%对 93%，<0.01）的责任明显较少。PCP 已经为随访制定了定制的、不一致的解决方案。在最令人担忧的情况下，描述了“双重安全网”，即患者和 PCP 都保留责任。
PCP 对随访保留责任的程度取决于他们对患者的关注程度和他们的初级保健系统的特性。目前，支持随访的综合系统未得到充分利用，似乎有必要对其开发、采用和有效性进行研究。
