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dc.contributor.authorWilson, Andrew
dc.contributor.authorColeby, Dawn
dc.contributor.authorRegan, Emma
dc.contributor.authorWindridge, Kate
dc.contributor.authorWillars, Janet
dc.contributor.authorRobinson, Tom
dc.contributor.authorPhelps, Kay
dc.date.accessioned2019-10-31T09:27:51Z
dc.date.available2019-10-31T09:27:51Z
dc.date.issued2016-05-17
dc.identifier.citationWilson, A., Coleby, D., Regen, E., Windridge, K., Willars, J., Robinson, T., Phelps, K. (2016) Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives. BMJ Open,6, e011654.en
dc.identifier.urihttps://dora.dmu.ac.uk/handle/2086/18678
dc.descriptionopen access articleen
dc.description.abstractObjective 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-specialistsen
dc.language.isoenen
dc.publisherBMJen
dc.titleService factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectivesen
dc.typeArticleen
dc.identifier.doihttps://doi.org/10.1136/bmjopen-2016-011654
dc.peerreviewedYesen
dc.funderNIHR (National Institute for Health Research)en
dc.projectidgrant number PB-PG-0906-10335en
dc.cclicenceCC-BY-NCen
dc.date.acceptance2016-04-26
dc.exception.ref2021codes254aen


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