Rufus-Toye Remi M, Rafati Fard Amir, Mowforth Oliver D, McCarron Luke V, Chan Kayen, Hirayama Yuri, Smith Emma K, Veremu Munashe, Davies Benjamin M, Brannigan Jamie F M
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
JMIR Form Res. 2024 Aug 19;8:e58802. doi: 10.2196/58802.
Degenerative cervical myelopathy (DCM) is a progressive neurological condition, characterized by spinal cord injury secondary to degenerative changes in the spine. Misdiagnosis in primary care forms part of a complex picture leading to an average diagnostic delay of 2 years. This leads to potentially preventable and permanent disability. A lack of awareness secondary to deficits in postgraduate education may contribute to these delays.
This study aims to assess the awareness of DCM in the setting of general practice.
General practitioners completed a quantitative web-based cross-sectional questionnaire. The 17-item questionnaire captured data regarding demographics, subjective awareness, and objective knowledge. The questionnaire was disseminated via professional networks, including via practice managers and senior practice partners. Incentivization was provided via a bespoke DCM fact sheet for those that completed the survey.
A total of 54 general practitioners representing all 4 UK nations responded to the survey. General practitioners most commonly self-assessed that they had "limited awareness" of DCM (n=24, 51%). General practitioners felt most commonly "moderately able" to recognize a case of DCM (n=21, 46%). In total, 13% (n=6) of respondents reported that they would not be at all able to recognize a patient with DCM. Respondents most commonly reported that they were "moderately confident" in their ability to triage a patient with DCM (n=19, 41%). A quarter of respondents reported no prior introduction to DCM throughout their medical training (n=13, 25%). The mean score for knowledge-based questions was 42.6% (SD 3.96%) with the lowest performance observed in patient demographic and clinical recognition items.
General practitioners lack confidence in the recognition and management of DCM. These findings are consistent with the diagnostic delays previously described in the literature at the primary care level. Further work to develop and implement educational interventions to general practitioner practices is a crucial step to improving patient outcomes in DCM.
退行性颈椎病脊髓病（DCM）是一种进行性神经疾病，其特征是继发于脊柱退行性变的脊髓损伤。基层医疗中的误诊是导致平均诊断延迟2年这一复杂情况的一部分。这会导致潜在可预防的永久性残疾。研究生教育不足导致的认识缺乏可能是造成这些延迟的原因之一。
本研究旨在评估全科医疗环境中对DCM的认识。
全科医生完成了一份基于网络的定量横断面问卷。这份包含17个条目的问卷收集了有关人口统计学、主观认识和客观知识的数据。问卷通过专业网络进行分发，包括通过诊所管理人员和资深诊所合伙人。为完成调查的人员提供了一份定制的DCM情况说明书作为激励。
代表英国所有四个地区的54名全科医生回复了调查。全科医生最常自我评估认为他们对DCM“认识有限”（n = 24，51%）。全科医生最常感觉自己“有一定能力”识别DCM病例（n = 21，46%）。总体而言，13%（n = 6）的受访者表示他们完全无法识别DCM患者。受访者最常报告称他们对分诊DCM患者的能力“有一定信心”（n = 19，41%）。四分之一的受访者报告称在整个医学培训过程中从未接触过DCM（n = 13，25%）。基于知识问题的平均得分是42.6%（标准差3.96%），在患者人口统计学和临床识别项目中的表现最差。
全科医生在识别和管理DCM方面缺乏信心。这些发现与之前文献中描述的基层医疗层面的诊断延迟情况一致。开展并实施针对全科医生诊所的教育干预措施的进一步工作是改善DCM患者治疗效果的关键一步。
