Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Br J Gen Pract. 2024 May 30;74(743):e393-e400. doi: 10.3399/BJGP.2023.0469. Print 2024 Jun.
Most healthcare contacts for children in the UK occur in general practice. Diagnostic tests can be beneficial in narrowing differential diagnoses; however, there is substantial variation in the use of tests for children in general practice. Unwarranted variation in testing can lead to variation in quality of care and may exacerbate health inequities. To our knowledge, no previous study has tried to understand why variation in testing exists for children in general practice.
To explore GPs' perspectives on using diagnostic tests for children in primary care and the underlying drivers of variation.
Qualitative study in which semi-structured interviews were conducted with GPs and trainee GPs in England.
Interviews were conducted with 18 GPs and two trainee GPs between April and June 2023. The interviews were transcribed and analysed using reflexive thematic analysis.
GPs reflected that their approach to testing in children differed from their approach to testing in adults: their threshold to test was higher, and their threshold to refer to specialists was lower. GPs' perceptions of test utility varied, including objective testing for asthma. Perceived drivers of variation in testing were intrinsic (clinician-specific) factors relating to their risk tolerance and experience; and extrinsic factors, including disease prevalence, parental concern and expectations of health care, workforce changes leading to fragmentation in care, time constraints, and differences in guidelines.
The findings of this study identify actionable issues for clinicians, researchers, and policymakers to address gaps in education, evidence, and guidance, reduce unwarranted differences in test use, and improve the quality of health care delivered to children in general practice.
在英国，大多数儿童的医疗保健接触都发生在全科医生诊所。诊断测试有助于缩小鉴别诊断的范围；然而，全科医生对儿童进行测试的使用存在很大差异。测试的不必要差异会导致护理质量的差异，并可能加剧健康不平等。据我们所知，以前没有研究试图了解为什么全科医生对儿童的测试存在差异。
探讨全科医生对初级保健中儿童使用诊断测试的看法以及导致差异的潜在驱动因素。
在英格兰对全科医生和实习全科医生进行了半结构化访谈的定性研究。
2023 年 4 月至 6 月期间，对 18 名全科医生和 2 名实习全科医生进行了访谈。访谈内容被转录并使用反思性主题分析进行分析。
全科医生反映，他们对儿童测试的方法与对成人测试的方法不同：他们对测试的门槛较高，对转介给专家的门槛较低。医生对测试效用的看法存在差异，包括哮喘的客观测试。测试差异的感知驱动因素包括与风险容忍度和经验相关的内在（临床医生特定）因素；以及外在因素，包括疾病流行率、父母的关注和对医疗保健的期望、导致护理碎片化的劳动力变化、时间限制以及指南的差异。
本研究的结果确定了临床医生、研究人员和政策制定者在教育、证据和指导方面需要解决的问题，以缩小测试使用方面的差距，减少不必要的测试差异，并提高全科医生为儿童提供的医疗保健质量。
