Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Br J Gen Pract. 2018 Sep;68(674):e594-e603. doi: 10.3399/bjgp18X698561. Epub 2018 Aug 13.
Direct access (DA) testing allows GPs to refer patients for investigation without consulting a specialist. The aim is to reduce waiting time for investigations and unnecessary appointments, enabling treatment to begin without delay.
To establish the proportion of patients diagnosed with cancer and other diseases through DA testing, time to diagnosis, and suitability of DA investigations.
Systematic review assessing the effectiveness of GP DA testing in adults.
MEDLINE, Embase, and the Cochrane Library were searched. Where possible, study data were pooled and analysed quantitatively. Where this was not possible, the data are presented narratively.
The authors identified 60 papers that met pre-specified inclusion criteria. Most studies were carried out in the UK and were judged to be of poor quality. The authors found no significant difference in the pooled cancer conversion rate between GP DA referrals and patients who first consulted a specialist for any test, except gastroscopy. There were also no significant differences in the proportions of patients receiving any non-cancer diagnosis. Referrals for testing were deemed appropriate in 66.4% of those coming from GPs, and in 80.9% of those from consultants; this difference was not significant. The time from referral to testing was significantly shorter for patients referred for DA tests. Patient and GP satisfaction with DA testing was consistently high.
GP DA testing performs as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction.
直接就诊（DA）检测允许全科医生在不咨询专家的情况下为患者转介进行检查。其目的是减少检查和不必要预约的等待时间，使治疗能够立即开始。
通过 DA 检测确定诊断为癌症和其他疾病的患者比例、诊断时间以及 DA 检测的适宜性。
系统评价评估了成人中 GP DA 检测的有效性。
检索 MEDLINE、Embase 和 Cochrane 图书馆。在可能的情况下，对研究数据进行了汇总和定量分析。在不可能的情况下，数据以叙述方式呈现。
作者确定了 60 篇符合预先指定纳入标准的论文。大多数研究在英国进行，被认为质量较差。作者发现，除了胃镜检查外，GP DA 转介与首次咨询专家进行任何检查的患者之间的癌症转化率没有显著差异。接受任何非癌症诊断的患者比例也没有显著差异。GP 转介的检测被认为是合适的，占 66.4%，而顾问转介的检测被认为是合适的，占 80.9%；这一差异没有统计学意义。从转介到检测的时间对于接受 DA 检测的患者来说明显更短。患者和 GP 对 DA 检测的满意度一直很高。
在疾病检测、转介适宜性、从转介到检测的时间间隔以及患者和 GP 的满意度等方面，GP DA 检测的表现与顾问分诊检测一样好，在某些方面甚至更好。
