From: The role of the GP in managing suspected transient ischaemic attack: a qualitative study
Factors influencing the role of the GP and urgency of GP referral | Examples |
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Clinical characteristics | • Established risk factors for TIA severitya • Symptom un/usual for this patient • Patient is a frequent attender (GP) • Additional illnesses • Frailty or age (GP) • Family history • Day of the week and time of day that symptoms occur (patient) • Duration between symptom onset and GP appointment (GP) |
General health beliefs and knowledge | • General health educational level/competence • Urgent cases need to go to A&E • Urgent cases can wait for up to two weeks • A specialist will be best placed to treat patients for a specific disorder • Hospital investigations should precede diagnosis and treatment • Patient choice/demand (GP) |
TIA beliefs and knowledge | • GP and patient knowledge of and belief in national guidelines/awareness campaigns • GP knowledge of local guidelines and referral pathways (GP) • If patient feels well it is not an emergency • A TIA is like a heart attack • Possible brain problems require brain scanning before treatment |
Personalities and relationships | • Anxious or concerned patient or GP • Unconcerned or “not wanting to be a nuisance” patient • GP and patient know each other • GP and patient speak the same language (A&E nurse) |
Support tools | • Referral forms (GP) • Hospital guidelines/ website • Telephone and fax access to hospital team • GP actions have the “hospital stamp of approval” • Availability of investigations such as carotid ultrasound and heart monitors • Hospital or other transport • Availability of specialist clinics |