Abstract:
BACKGROUND:The average delay in diagnosis for patients with axial spondyloarthritis (axSpA) is 7 to 10 years. Factors that contribute to this delay are multifactorial and include the lack of diagnostic criteria (although classification criteria exist) for axSpA and the difficulty in distinguishing inflammatory back pain, a key symptom of axSpA, from other highly prevalent forms of low back pain. We sought to describe reasons for diagnostic delay for axSpA provided by primary care physicians. METHODS:We conducted a qualitative research study which included 18 US primary care physicians, balanced by gender. Physicians provided informed consent to participate in an in-depth interview (< 60 min), conducted in person (n = 3) or over the phone (n = 15), in 2019. The analysis focuses on thoughts about factors contributing to diagnostic delay in axSpA. RESULTS:Physicians noted that the disease characteristics contributing to diagnostic delay include: back pain is common and axSpA is less prevalent, slow progression of axSpA, intermittent nature of axSpA pain, and in the absence of abnormal radiographs of the spine or sacroiliac joints, there is no definitive test for axSpA. Patient characteristics believed to contribute to diagnostic delay included having multiple conditions in need of attention, infrequent interactions with the health care system, and "doctor shopping." Doctors noted that patients wait until the last moments of the clinical encounter to discuss back pain. Problematic physician characteristics included lack of rapport with patients, lack of setting appropriate expectations, and attribution of back pain to other factors. Structural/system issues included short appointments, lack of continuity of care, insufficient insurance coverage for tests, lack of back pain clinics, and a shortage of rheumatologists. CONCLUSION:Primary care physicians agreed that lengthy axSpA diagnosis delays are challenging to address owing to the multifactorial causes (e.g., disease characteristics, patient characteristics, lack of definitive tests, system factors).
journal_name
BMC Fam Practjournal_title
BMC family practiceauthors
Lapane KL,Khan S,Shridharmurthy D,Beccia A,Dubé C,Yi E,Kay J,Liu SHdoi
10.1186/s12875-020-01274-ysubject
Has Abstractpub_date
2020-09-29 00:00:00pages
204issue
1issn
1471-2296pii
10.1186/s12875-020-01274-yjournal_volume
21pub_type
杂志文章abstract:BACKGROUND:In the Netherlands, about half of the patient contacts with a general practitioner (GP) cooperative are nonurgent from a medical perspective. A part of these problems can wait until office hours or can be managed by the patient himself without further professional care. However, from the patient's perspectiv...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0376-9
更新日期:2015-10-28 00:00:00
abstract:BACKGROUND:Evidence-based medicine (EBM) is gradually being recognized worldwide as an important clinical skill and plays an important role in health care. Although the concept has successfully spread in the health care field, EBM still has not been widely incorporated into clinical decisions in primary care due to pot...
journal_title:BMC family practice
pub_type: 杂志文章
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更新日期:2019-12-06 00:00:00
abstract:BACKGROUND:While trust in physicians has been rigorously investigated regarding its concept, measurement, and factors, the studies have mainly focused on the attributes of the physicians. This approach can lead to a limited understanding of trust in physicians as trust is based on the relationship, an interaction of bo...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-018-0875-6
更新日期:2018-11-29 00:00:00
abstract:BACKGROUND:The utility of clinical exercise tests depends on their support of treatment decisions. We sought to assess the utility of exercise tests for the selection of primary-care patients for referral to cardiologic care, and to determine whether referral decisions were biased by gender or socioeconomic status. We ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-014-0182-9
更新日期:2014-11-30 00:00:00
abstract:BACKGROUND:In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (E...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-01138-5
更新日期:2020-04-14 00:00:00
abstract:BACKGROUND:Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC) has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A n...
journal_title:BMC family practice
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更新日期:2012-10-10 00:00:00
abstract:BACKGROUND:General practitioners (GPs) are ideally placed to bridge the widely noted evidence-practice gap between current management of NVAF and the need to increase anticoagulant use to reduce the risk of fatal and disabling stroke in NVAF. We aimed to identify gaps in current care, and asked GPs to identify potentia...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-62
更新日期:2008-11-13 00:00:00
abstract:BACKGROUND:Low patient satisfaction with the quality of out-of-hours primary care (OOH-PC) has been linked with several individual and organizational factors. However, findings have been ambiguous and may not apply to the Danish out-of-hours (OOH) setting in which general practitioners (GPs) perform the initial telepho...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-017-0681-6
更新日期:2018-01-11 00:00:00
abstract:BACKGROUND:Late diagnosis is considered to be a major factor contributing to poorer cancer survival rates in the UK. Interventions have focussed on the promotion of earlier diagnosis in patients with potential cancer symptoms. However, to assess the effectiveness of these interventions, the time from symptom onset to p...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-014-0167-8
更新日期:2014-10-25 00:00:00
abstract:BACKGROUND:Symptoms of cancer may be interpreted differently by different patients before the diagnosis. This study investigated symptom attributions in Danish patients with colorectal cancer and the potential associations with symptom type, socio-demographic characteristics and patient interval. METHODS:Data were col...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0315-9
更新日期:2015-09-03 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0272-3
更新日期:2015-05-14 00:00:00
abstract:BACKGROUND:Many tools exist to guide family physicians' impressions about frailty status of older adults, but no single tool, instrument, or set of criteria has emerged as most useful. The role of physicians' subjective impressions in frailty decisions has not been studied. This study explores how family physicians con...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-018-0743-4
更新日期:2018-05-14 00:00:00
abstract:BACKGROUND:There is a growing emphasis on self-monitoring applications that allow patients to measure their own physical health parameters. A prerequisite for achieving positive effects is patients' willingness to self-monitor. The controllability of disease types, patients' perceived self-efficacy and health problems ...
journal_title:BMC family practice
pub_type: 杂志文章,多中心研究
doi:10.1186/s12875-017-0615-3
更新日期:2017-03-20 00:00:00
abstract:BACKGROUND:Upper respiratory tract infections (URTI) are common. The etiologic factor is usually viral, but many physicians prescribe antibiotics. We aimed to evaluate parents' expectations of and knowledge about the role of antibiotics in childhood URTI. METHODS:The study was conducted in thirteen primary care pediat...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-4-20
更新日期:2003-12-30 00:00:00
abstract:BACKGROUND:Ultrasound imaging is utilized in Swiss primary care; however, little is known regarding the extent to which it is performed. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine the clinical indications of ultrasound in Swiss general practice...
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doi:10.1186/s12875-020-01209-7
更新日期:2020-07-01 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-9-22
更新日期:2008-04-20 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-01170-5
更新日期:2020-06-05 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-11-70
更新日期:2010-09-22 00:00:00
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更新日期:2015-12-15 00:00:00
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更新日期:2012-02-16 00:00:00
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更新日期:2013-10-11 00:00:00
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更新日期:2015-07-29 00:00:00
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doi:10.1186/s12875-017-0612-6
更新日期:2017-03-17 00:00:00
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更新日期:2016-02-02 00:00:00
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pub_type: 杂志文章
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更新日期:2010-02-01 00:00:00