Service factors causing delay in specialist assessment for TIA and minor stroke: A qualitative study of GP and patient perspectives

Andrew Wilson, Dawn Coleby, Emma Regan, Kay Phelps, Kate Windridge, Janet Willars, Tom Robinson

Research output: Contribution to journalArticle

4 Citations (Scopus)
23 Downloads (Pure)

Abstract

Objective: To understand how service factors contribute to delays to specialist assessment following transient ischaemic attack (TIA) or minor stroke.

Design: Qualitative study using semistructured interviews, analysis by constant comparison.

Setting: Leicester, UK.

Participants: Patients diagnosed with TIA or minor stroke, at hospital admission or in a rapid-access TIA clinic (n=42), general practitioners (GPs) of participating patients if they had been involved in the patients’ care (n=18).

Data: Accounts from patients and GPs of factors contributing to delay following action to seek help from a healthcare professional (HCP).

Results: The following categories of delay were identified. First, delay in assessment in general practice following contact with the service; this related to availability of same day appointments, and the role of the receptionist in identifying urgent cases. Second, delays in diagnosis by the HCP first consulted, including GPs, optometrists, out-of-hours services, walk-in centres and the emergency department. Third, delays in referral after a suspected diagnosis; these included variable use of the ABCD2 (Age, Blood pressure, Clinical features, Duration, Diabetes) risk stratification score and referral templates in general practice, and referral back to the patients’ GP in cases where he/she was not the first HCP consulted.

Conclusions: Primary and emergency care providers need to review how they can best handle patients presenting with symptoms that could be due to stroke or TIA. In general practice, this may include receptionist training and/or triage by a nurse or doctor. Mechanisms need to be established to enable direct referral to the TIA clinic when patients whose symptoms have resolved present to other agencies. Further work is needed to improve diagnostic accuracy by non-specialists.

Publisher Statement: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Original languageEnglish
Article numbere011654
JournalBMJ Open
Volume6
Issue number5
DOIs
Publication statusPublished - 1 May 2016
Externally publishedYes

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Transient Ischemic Attack
General Practitioners
Stroke
Referral and Consultation
General Practice
Licensure
Delivery of Health Care
Triage
Emergency Medical Services
Hospital Emergency Service
Primary Health Care
Patient Care
Appointments and Schedules
Nurses
Interviews
Blood Pressure

Cite this

Service factors causing delay in specialist assessment for TIA and minor stroke : A qualitative study of GP and patient perspectives. / Wilson, Andrew; Coleby, Dawn; Regan, Emma; Phelps, Kay ; Windridge, Kate; Willars, Janet; Robinson, Tom.

In: BMJ Open, Vol. 6, No. 5, e011654, 01.05.2016.

Research output: Contribution to journalArticle

Wilson, Andrew ; Coleby, Dawn ; Regan, Emma ; Phelps, Kay ; Windridge, Kate ; Willars, Janet ; Robinson, Tom. / Service factors causing delay in specialist assessment for TIA and minor stroke : A qualitative study of GP and patient perspectives. In: BMJ Open. 2016 ; Vol. 6, No. 5.
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T1 - Service factors causing delay in specialist assessment for TIA and minor stroke

T2 - A qualitative study of GP and patient perspectives

AU - Wilson, Andrew

AU - Coleby, Dawn

AU - Regan, Emma

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N2 - Objective: To understand how service factors contribute to delays to specialist assessment following transient ischaemic attack (TIA) or minor stroke.Design: Qualitative study using semistructured interviews, analysis by constant comparison.Setting: Leicester, UK.Participants: Patients diagnosed with TIA or minor stroke, at hospital admission or in a rapid-access TIA clinic (n=42), general practitioners (GPs) of participating patients if they had been involved in the patients’ care (n=18).Data: Accounts from patients and GPs of factors contributing to delay following action to seek help from a healthcare professional (HCP).Results: The following categories of delay were identified. First, delay in assessment in general practice following contact with the service; this related to availability of same day appointments, and the role of the receptionist in identifying urgent cases. Second, delays in diagnosis by the HCP first consulted, including GPs, optometrists, out-of-hours services, walk-in centres and the emergency department. Third, delays in referral after a suspected diagnosis; these included variable use of the ABCD2 (Age, Blood pressure, Clinical features, Duration, Diabetes) risk stratification score and referral templates in general practice, and referral back to the patients’ GP in cases where he/she was not the first HCP consulted.Conclusions: Primary and emergency care providers need to review how they can best handle patients presenting with symptoms that could be due to stroke or TIA. In general practice, this may include receptionist training and/or triage by a nurse or doctor. Mechanisms need to be established to enable direct referral to the TIA clinic when patients whose symptoms have resolved present to other agencies. Further work is needed to improve diagnostic accuracy by non-specialists.Publisher Statement: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

AB - Objective: To understand how service factors contribute to delays to specialist assessment following transient ischaemic attack (TIA) or minor stroke.Design: Qualitative study using semistructured interviews, analysis by constant comparison.Setting: Leicester, UK.Participants: Patients diagnosed with TIA or minor stroke, at hospital admission or in a rapid-access TIA clinic (n=42), general practitioners (GPs) of participating patients if they had been involved in the patients’ care (n=18).Data: Accounts from patients and GPs of factors contributing to delay following action to seek help from a healthcare professional (HCP).Results: The following categories of delay were identified. First, delay in assessment in general practice following contact with the service; this related to availability of same day appointments, and the role of the receptionist in identifying urgent cases. Second, delays in diagnosis by the HCP first consulted, including GPs, optometrists, out-of-hours services, walk-in centres and the emergency department. Third, delays in referral after a suspected diagnosis; these included variable use of the ABCD2 (Age, Blood pressure, Clinical features, Duration, Diabetes) risk stratification score and referral templates in general practice, and referral back to the patients’ GP in cases where he/she was not the first HCP consulted.Conclusions: Primary and emergency care providers need to review how they can best handle patients presenting with symptoms that could be due to stroke or TIA. In general practice, this may include receptionist training and/or triage by a nurse or doctor. Mechanisms need to be established to enable direct referral to the TIA clinic when patients whose symptoms have resolved present to other agencies. Further work is needed to improve diagnostic accuracy by non-specialists.Publisher Statement: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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DO - 10.1136/bmjopen-2016-011654

M3 - Article

VL - 6

JO - The BMJ

JF - The BMJ

SN - 2044-6055

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