PDF(Pubmed)
Abstract：
BACKGROUND: 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.
OBJECTIVE: To explore GPs\' perspectives on using diagnostic tests for children in primary care and the underlying drivers of variation.
METHODS: Qualitative study in which semi-structured interviews were conducted with GPs and trainee GPs in England.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
OBJECTIVE: To explore GPs\' perspectives on using diagnostic tests for children in primary care and the underlying drivers of variation.
METHODS: Qualitative study in which semi-structured interviews were conducted with GPs and trainee GPs in England.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景技术英国儿童的大多数医疗保健接触发生在一般实践中。诊断测试可以有益于缩小鉴别诊断，然而,在一般实践中，儿童测试的使用存在很大差异。测试中的不必要变化会导致护理质量的变化，并加剧健康不平等。先前没有研究试图理解为什么在一般实践中儿童存在测试差异。目的探讨GP对初级保健儿童使用诊断测试的观点以及变化的潜在驱动因素。设计和设置对英格兰的全科医生和实习生全科医生进行了半结构化访谈。方法我们在2023年4月至6月间对18名全科医生和2名学员进行了访谈。采访是按主题进行转录和分析的。结果全科医生反映出他们在儿童中的测试方法与成年人不同；他们的测试门槛较高，但是参考专家的门槛较低。全科医生对测试效用的看法各不相同，包括哮喘的客观检测。感知到的变化驱动因素包括：1）与他们的风险承受能力和经验相关的内在（临床医生）因素，2)外在因素，包括疾病患病率，父母对医疗保健的关注和期望，劳动力变化导致护理分散，时间限制和准则的差异。结论这项研究的结果为临床医生确定了可行的问题，研究人员,和政策制定者解决教育差距，证据,和指导,减少测试使用中不必要的差异，并提高一般实践中提供给儿童的医疗保健质量。
