Vegter, L. (2016) Effect van scholing op de diagnostische nauwkeurigheid van huisartsen bij (pre)maligne huidafwijkingen : Retrospectieve studie naar het effect van dermatologie scholing op de diagnostische nauwkeurigheid van huisartsen bij huidafwijkingen die ingestuurd w. thesis, Medicine.
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Abstract
Summary Introduction The incidence of skin cancer in the Netherlands is raising, due to the increase in ageing population, increased exposure to sunlight and a raised public awareness of this condition. The capacity of dermatologists falls short and the diagnosis and treatment of (malignant) skin lesions shifts to primary care. General practitioners (GPs) do not have guidelines and are free to make policy concerning excisions/biopsies and any request for histopathological examination. Accurate diagnosis of skin malignancies is of great importance, in view of the potential morbidity and mortality. Little research has been done to determine the effect of training on the diagnostics accuracy.* The aim of this study was to explore if training has a long term effect on the diagnostic accuracy in primary care. In addition, we investigated whether factors related to general practitioners can be identified which affect the accuracy. Methods This retrospective study analyzed 17971 requests for histopathology examination received from 145 GPs from 2012 till 2015. The sensitivity before and after the facultative Interline dermatology training was determined. The histopathological result was used as the gold standard. The suspicion for a malignancy was compared with confirmed (pre)malignant lesions. The objective of the training was: being able to make a clinical distinction between certain and uncertain benign lesions. In addition, 99 GPs completed a questionnaire about their practices regarding skin lesions. A multivariate analysis was used to determine which factors influence the sensitivity of the diagnosis (pre)malignancy. Results The sensitivity of the diagnosis (pre)malignancy based on histopathology requests before and after the training revealed no differences (respectively 61.9, 61.7%, p=0.897). A subgroup analysis with paired data before and after the training showed an equal sensitivity of 66.7% (p=0.775). The specificity, positive predictive value, negative predictive value and the Cohen’s kappa coefficient revealed no differences, neither the sensitivity of the individual malignant diagnoses. The multivariate analysis with factors retrieved from the questionnaire revealed an increase in sensitivity in case of a strong interest in dermatology and the 6-10 times per week use of a dermatoscope. Conclusion The effect of training on the diagnostic accuracy of excisions and biopsies with a histopathological examination request from the primary care could not be demonstrated. A strong interest and the 6-10 times per week use of a dermatoscope showed a positive effect on the sensitivity. More prospective studies are needed to determine the effect of training and other factors on the diagnostic accuracy. These studies need a long follow-up and control of confounders. GPs should be encouraged for the trained use of a dermatoscope. The development of a guideline for primary care and the opportunity of referrals between primary caregivers should be considered.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleiders and Bol, Dr. M.G.W. patholoog and Bart, Dr. J. patholoog and Instelling Isala Zwolle Afdeling pathologie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:39 |
| Last Modified: | 25 Jun 2020 10:39 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/106 |
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