Impact of a continuing medical education meeting on the use and timing of urgent cancer referrals among general practitioners - a before-after study

Berit Skjødeberg Toftegaard*, Flemming Bro, Alina Zalounina Falborg, Peter Vedsted

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

7 Citations (Scopus)

Abstract

Background: Detection of cancer in general practice is challenging because symptoms are diverse. Even so-called alarm symptoms have low positive predictive values of cancer. Nevertheless, appropriate referral is crucial. As 85% of cancer patients initiate their cancer diagnostic pathway in general practice, a Continuing Medical Education meeting (CME-M) in early cancer diagnosis was launched in Denmark in 2012. We aimed to investigate the effect of the CME-M on the primary care interval, patient contacts with general practice and use of urgent cancer referrals. Methods: A before-after study was conducted in the Central Denmark Region included 396 general practices, which were assigned to one of eight geographical clusters. Practices were invited to participate in the CME-M with three-week intervals between clusters. Based on register data, we calculated urgent referral rates and patient contacts with general practice before referral. Information about primary care intervals was collected by requesting general practitioners to complete a one-page form for each urgent referral during an 8-month period around the time of the CME-Ms. CME-M practices were compared with non-participating reference practices by analysing before-after differences. Results: Forty percent of all practices participated in the CME-M. There was a statistically significant reduction in the number of total contacts with general practice from urgently referred patients in the month preceding the referral and an increase in the proportion of patients who waited 14 days or more in general practice from the reported date of symptom presentation to the referral date from before to after the CME-M in the CME-M group compared to the reference group. Conclusions: We found a reduced number of total patient contacts with general practice within the month preceding an urgent referral and an increase in the reported primary care intervals of urgently referred patients in the CME-M group. The trend towards higher urgent referral rates and longer primary care intervals may suggest raised awareness of unspecific cancer symptoms, which could cause the GP to register an earlier date of first symptom presentation. The standardised CME-M may contribute to optimising the timing and the use of urgent cancer referral. Trial registration: NCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014.

Original languageEnglish
Article number44
JournalBMC Family Practice
Volume18
Issue number1
ISSN1471-2296
DOIs
Publication statusPublished - 21 Mar 2017
Externally publishedYes

Bibliographical note

Funding Information:
The project was supported by the Foundation for Primary Health Care Research (Praksisforskningsfonden) of the Central Denmark Region, the Committee for Quality Improvement and Continuing Medical Education (KEU) of the Central Denmark Region, the Committee of Multi-practice Studies in General Practice (MPU) of the Danish College of General Practitioners (DSAM), the Danish Cancer Society and the Novo Nordisk Foundation. The sponsoring organisations were not involved in any part of the study.

Publisher Copyright:
© 2017 The Author(s).

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

Keywords

  • Behavioural change
  • Continuing medical education meeting
  • Denmark
  • Diagnosis
  • Early detection of cancer
  • General practice
  • Primary care interval
  • Referral rate
  • Use of health care

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