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Early diagnostic suggestions improve accuracy of GPs: a randomised controlled trial using computer-simulated patients.

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Title: Early diagnostic suggestions improve accuracy of GPs: a randomised controlled trial using computer-simulated patients.
Authors: Kostopoulou, O
Rosen, A
Round, T
Wright, E
Douiri, A
Delaney, B
Item Type: Journal Article
Abstract: Background: Designers of computerised diagnostic support systems (CDSSs) expect physicians to notice when they need advice and enter into the CDSS all information that they have gathered about the patient. The poor use of CDSSs and the tendency not to follow advice once a leading diagnosis emerges would question this expectation. Aim: To determine whether providing GPs with diagnoses to consider before they start testing hypotheses improves accuracy. Design and setting: Mixed factorial design, where 297 GPs diagnosed nine patient cases, differing in difficulty, in one of three experimental conditions: control, early support, or late support. Method: Data were collected over the internet. After reading some initial information about the patient and the reason for encounter, GPs requested further information for diagnosis and management. Those receiving early support were shown a list of possible diagnoses before gathering further information. In late support, GPs first gave a diagnosis and were then shown which other diagnoses they could still not discount. Results: Early support significantly improved diagnostic accuracy over control (odds ratio [OR] 1.31; 95% confidence interval [95%CI] = 1.03 to 1.66, P?=?0.027), while late support did not (OR 1.10; 95% CI = 0.88 to 1.37). An absolute improvement of 6% with early support was obtained. There was no significant interaction with case difficulty and no effect of GP experience on accuracy. No differences in information search were detected between experimental conditions. Conclusion: Reminding GPs of diagnoses to consider before they start testing hypotheses can improve diagnostic accuracy irrespective of case difficulty, without lengthening information search.
Issue Date: 1-Jan-2015
URI: http://hdl.handle.net/10044/1/25425
DOI: http://dx.doi.org/10.3399/bjgp15X683161
Start Page: e49
End Page: e54
Journal / Book Title: Br J Gen Pract
Volume: 65
Issue: 630
Copyright Statement: © British Journal of General Practice 2015 This is an OpenAccess article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Conference Place: England
Appears in Collections:Department of Surgery and Cancer



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