Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMC Fam Pract. 2019 Apr 26;20(1):56. doi: 10.1186/s12875-019-0941-8.
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.
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.
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.
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.
老年人的严重感染与非计划性住院和高死亡率有关。识别严重感染的存在并做出准确诊断是全科医生面临的重要挑战。本研究旨在探讨英国全科医生在诊断老年患者严重感染时面临的问题。
使用半结构化访谈进行定性研究。从英国各地的 27 家实践中，有目的地抽取了 28 名全科医生，以在全科医生的角色、经验和实践人群方面实现最大差异。访谈首先要求参与者描述他们最近或记忆深刻的评估疑似严重感染老年患者的病例。从主题指南中进一步提出其他问题来探讨挑战。对访谈记录进行编码和分析采用了一种改进的框架方法。
参与的全科医生认为诊断老年患者的严重感染具有挑战性，诊断往往不确定。促成因素包括患者的复杂性、非典型表现，以及由于连续性丧失而导致对患者缺乏了解。诊断挑战存在于患者评估的各个阶段。评分系统主要用作沟通工具。有时会进行检查以解决诊断不确定性，但检查的可用性和结果的速度限制了其实际使用。与患者及其家属共享明确的安全网计划有助于全科医生管理持续存在的不确定性。
在初级保健中评估患有严重感染的老年患者时，诊断挑战始终存在。支持全科医生提供连续性护理可能会提高识别能力，开发用于社区环境的即时护理检测可能会减少诊断不确定性。
