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GPs' perspectives on diagnostic tests for children: a qualitative interview study
Elizabeth T Thomas1, Margaret Glogowska2, Gail Hayward2
1Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Insights
General practitioners (GPs) use diagnostic tests differently for children than adults, with higher testing thresholds. Factors like clinician experience and parental concerns drive this variation in primary care.
Area of Science:
- Pediatric Primary Care
- Diagnostic Test Utilization
- Health Services Research
Background:
- Most pediatric healthcare encounters in the UK occur in general practice.
- Significant variation exists in the use of diagnostic tests for children in primary care.
- Unwarranted variation can impact care quality and exacerbate health inequities.
Purpose of the Study:
- To investigate general practitioners' (GPs) perspectives on diagnostic test use in pediatric primary care.
- To identify the underlying factors contributing to variation in testing practices for children.
Main Methods:
- A qualitative study involving semi-structured interviews with 18 GPs and 2 trainee GPs in England.
- Interviews were conducted between April and June 2023.
- Data were analyzed using reflexive thematic analysis.
Main Results:
- GPs reported a higher threshold for testing and a lower threshold for specialist referral in children compared to adults.
- Perceived test utility varied, with specific examples like objective testing for asthma.
- Identified drivers of variation included clinician-specific factors (risk tolerance, experience) and external factors (parental concerns, time constraints, guidelines).
Conclusions:
- Findings highlight areas for improvement in education, evidence, and clinical guidelines.
- Addressing these issues can help reduce unwarranted variation in diagnostic test use.
- Improving test utilization can enhance the quality of healthcare for children in general practice.
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.
Aim:
To explore GPs' perspectives on using diagnostic tests for children in primary care and the underlying drivers of variation.
Design And Setting:
Qualitative study in which semi-structured interviews were conducted with GPs and trainee GPs in England.
Method:
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.
Conclusion:
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.
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