Managing chest pain patients in general practice: an interview-based study

Leen Biesemans, Lotte E. Cleef, Robert T. A. Willemsen*, Beatrijs B. N. Hoorweg, Walter S. Renier, Frank Buntinx, Jan F. C. Glatz, Geert-Jan Dinant

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Web of Science)

Abstract

Background: Assessment of chest pain in general practice is challenging. General practitioners (GPs) often feel uncertainty when dealing with chest pain. The role of new diagnostic tools is yet unclear. Therefore, we aimed to learn: (1) whether or not GPs experience a change in incidence and presentation of chest pain, (2) how GPs deal with uncertainty, and (3) which thoughts, demands and doubts concerning new diagnostic tools occur. Methods: Semi-structured, face to face interview based study, aiming at six main subjects: experienced changes in prevalence of chest pain, the management of chest pain patients, dealing with uncertainty, the GPs' approach in referring chest pain patients, GPs' attitude towards 'unnecessary' referrals, and the GPs' suggestions for improving the management of chest pain patients. Results: 145 GPs in Belgium and the Netherlands were invited to participate, 27 (15 Flemish and 12 Dutch) GPs were interviewed. Data saturation was reached. The number of patients having an acute coronary syndrome among chest pain patients is decreasing, whereas the presentation of atypical complaints increases, together leading to more uncertainty. GPs rely on their own judgment above all, and desire new diagnostic tools only when these tools are of proven added value. Conclusion: The incidence of chest pain in general practice is not decreasing according to the GPs. However, the presentation of chest pain is changing. GPs feel relatively comfortable with referring a considerable number of chest pain patients without ACS, as over-referral is safe. Uncertainty is regarded as a substantial element of their profession. New diagnostic tools are awaited with cautiousness.
Original languageEnglish
Article number80
Number of pages9
JournalBMC Family Practice
Volume19
DOIs
Publication statusPublished - 2 Jun 2018

Keywords

  • General practice
  • Cardiovascular disorders
  • Diagnostic tests
  • Urgent care
  • Risk assessment
  • ACUTE CORONARY SYNDROME
  • OUT-OF-HOURS
  • PRIMARY-CARE
  • MYOCARDIAL-INFARCTION
  • HEART-DISEASE
  • REFERRALS
  • DIAGNOSIS
  • EMERGENCY
  • PRACTITIONERS
  • MANAGEMENT

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