背景:用于性传播感染(STI)测试的数字分诊工具可以潜在地用作全科医生(GP)降低工作压力的分诊的替代品。所研究的工具基于医学指南。同样的准则支持GP的决策过程。然而,研究表明,全科医生从整体角度做出决策,因此,不要总是遵守这些准则。要拥有高质量的数字分诊工具,从而实现高效的护理流程,了解更多关于全科医生的决策过程是很重要的。
目的:第一个目的是确定所研究的数字分诊工具的建议是否与全科医生的日常医疗实践相一致。第二个目标是了解哪些因素影响全科医生关于转诊诊断测试的决定。此外,这项研究提供了对全科医生决策过程的见解。
方法:使用半结构化访谈进行了基于定性小插图的研究。总的来说,与参与者(GP)讨论了代表患者病例的6个小插图。参与者需要大声思考他们是否会建议患者进行STI测试以及原因。对访谈笔录进行了专题分析。小插图患者病例也通过数字分诊工具,导致建议测试或不测试性传播感染。对该工具的建议和参与者的建议进行了比较。
结果:总计,进行了10次采访。参与者(GP)的平均年龄为48.30(SD11.88)岁。对于3个小插曲,数字分诊工具和所有参与者的建议是相同的。在那些小插曲中,患者的危险因素足够清楚,参与者建议与数字工具相同.对于3个小插曲,数字工具的建议与参与者的建议不同。影响参与者决策过程的患者相关因素是患者的焦虑,年轻的年龄,和接受测试的意愿。由于这些因素,参与者将在比分类工具更低的阈值进行测试。有时候,参与者想要的信息比插图中提供的更多,或者想要进行体检。这些元素不是数字分类工具的一部分。
结论:进行诊断性STI测试的建议在数字分诊工具和全科医生之间有所不同。数字分诊工具只考虑医疗指南,而全科医生则愿意从整体角度讨论推理。全科医生的决策过程受到患者焦虑的影响,愿意接受测试,和年龄。根据这些结果,我们相信,用于STI测试的数字分诊工具可以支持GP,甚至可以在将来取代咨询。进一步的研究必须证实如何安全地做到这一点。
BACKGROUND: Digital triage tools for sexually transmitted infection (STI) testing can potentially be used as a substitute for the triage that general practitioners (GPs) perform to lower their work pressure. The studied tool is based on medical guidelines. The same guidelines support GPs\' decision-making process. However, research has shown that GPs make decisions from a holistic perspective and, therefore, do not always adhere to those guidelines. To have a high-quality digital triage tool that results in an efficient care process, it is important to learn more about GPs\' decision-making process.
OBJECTIVE: The first objective was to identify whether the advice of the studied digital triage tool aligned with GPs\' daily medical practice. The second objective was to learn which factors influence GPs\' decisions regarding referral for diagnostic testing. In addition, this
study provides insights into GPs\' decision-making process.
METHODS: A qualitative vignette-based
study using semistructured interviews was conducted. In total, 6 vignettes representing patient cases were discussed with the participants (GPs). The participants needed to think aloud whether they would advise an STI test for the patient and why. A thematic analysis was conducted on the transcripts of the interviews. The vignette patient cases were also passed through the digital triage tool, resulting in advice to test or not for an STI. A comparison was made between the advice of the tool and that of the participants.
RESULTS: In total, 10 interviews were conducted. Participants (GPs) had a mean age of 48.30 (SD 11.88) years. For 3 vignettes, the advice of the digital triage tool and of all participants was the same. In those vignettes, the patients\' risk factors were sufficiently clear for the participants to advise the same as the digital tool. For 3 vignettes, the advice of the digital tool differed from that of the participants. Patient-related factors that influenced the participants\' decision-making process were the patient\'s anxiety, young age, and willingness to be tested. Participants would test at a lower threshold than the triage tool because of those factors. Sometimes, participants wanted more information than was provided in the vignette or would like to conduct a physical examination. These elements were not part of the digital triage tool.
CONCLUSIONS: The advice to conduct a diagnostic STI test differed between a digital triage tool and GPs. The digital triage tool considered only medical guidelines, whereas GPs were open to discussion reasoning from a holistic perspective. The GPs\' decision-making process was influenced by patients\' anxiety, willingness to be tested, and age. On the basis of these results, we believe that the digital triage tool for STI testing could support GPs and even replace consultations in the future. Further research must substantiate how this can be done safely.