School for Primary Care Research Increasing the evidence base for primary care practice The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge, Manchester and Oxford and is part of the National Institute for Health Research. School for Primary Care Research William Hamilton, Professor of primary care diagnostics, Peninsula College of Medicine and Dentistry The Hamilton risk assessment tools – what are they and how can we use them?
Transcript
School for Primary
Care Research
Increasing the
evidence base for primary care
practice
The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge, Manchester and Oxford and is part of the National Institute for Health Research.
School for Primary Care Research
William Hamilton, Professor of primary care diagnostics, Peninsula College of Medicine and Dentistry
The Hamilton risk assessment tools – what are they and how
can we use them?
School for Primary
Care Research
Increasing the
evidence base for primary care
practice
The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge, Manchester and Oxford and is part of the National Institute for Health Research.
School for Primary Care Research
The problem
• The UK has a relatively poor track record when compared with other European countries.
• In part this is due to late diagnosis, with an estimated 7,500+ lives lost annually
• Later diagnosis can be due to late presentation, non-recognition of cancer as a possibility by us GPs, or delays in secondary care (or a mixture of these).
School for Primary
Care Research
Increasing the
evidence base for primary care
practice
The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge, Manchester and Oxford and is part of the National Institute for Health Research.
School for Primary Care Research
The problem: colon
• This is one of the four commonest cancers, and possibly the one with most to benefit from improvements in diagnosis.
• Half of patients never have a NICE-qualifying symptom
• Only a quarter are diagnosed via 2-week rule clinics
• A quarter present as emergencies• Earlier diagnosis may give a stage shift or
prevent some of the emergencies
School for Primary
Care Research
Increasing the
evidence base for primary care
practice
The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge, Manchester and Oxford and is part of the National Institute for Health Research.
School for Primary Care Research
The problem: lung
• This is the commonest cause of cancer death in the UK.
• Mortality is high, as very few are diagnosed at an operable stage.
• There is an easy test – the chest X-ray - but no screening test.
• Almost all present to GPs with symptoms.
School for Primary
Care Research
Increasing the
evidence base for primary care
practice
The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge, Manchester and Oxford and is part of the National Institute for Health Research.
School for Primary Care Research
The problem: we GPs do a good job as gatekeepers
• We are justifiably proud of UK general practice
• The gatekeeper role has brought many benefits to patients, not least by ensuring the correct specialist is seen
• It has also brought disadvantages, arising from GPs’ desire to use resources appropriately.
• In cancer this means not investigating the low-risk symptom – and NICE tells us not to.
School for Primary
Care Research
Increasing the
evidence base for primary care
practice
The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge, Manchester and Oxford and is part of the National Institute for Health Research.
School for Primary Care Research
How do we select patients for cancer investigation?
• Some is from hands-on experience
• Some from ‘gut feeling’
• Some from advice – like NICE
• Some from patient pressure
• Some from reading up research
School for Primary
Care Research
Increasing the
evidence base for primary care
practice
The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge, Manchester and Oxford and is part of the National Institute for Health Research.
School for Primary Care Research
The research behind this programme
• We found all the cancers in an area in Devon, and generated five controls for each
• Identified all symptoms reported to GPs before diagnosis
• Identified which symptoms were relevant
• Estimated the ‘risk’ of cancer for each symptom in a patient attending their GP
