Schutte, E. (2012) Monitoren werkafspraak punctiecytologie. thesis, Medicine.
Full text available on request.Abstract
Introduction: In 2011 the working agreement between primary and specialist care on fine needle aspiration (FNA) was introduced in Zwolle. FNA is a simple and fast way for obtaining material used in the diagnosis of tumors. The working agreement enables general practioners (GPs) to ask a pathologist to perform FNA without having to refer the patient to a specialist. This means that the patient can stay under the primary care of the GP, thus sparing the costs of expensive specialist care. Furthermore, FNA is a patient-friendly diagnostic method due to the possibility of fast diagnosis and the relatively less invasive nature of the procedure. This study investigates whether GPs request more FNA after being informed on the working agreement via a so called ‘Interline course’, and thereby reduce medical costs and improve the medical care in the region of Zwolle. Material and methods: Data on FNA was obtained from the Pathologisch Anatomisch Landelijk Geautomatiseerd Archief (PALGA) from June 2010 to May 2012. 514 cases of FNA with their results and other tests performed on the obtained material were found. An estimation was made of where the cases of benign tumors would be referred to when diagnosed by a specialist and of the amount of money saved by keeping these patients in primary care. Furthermore, we investigated how many aspirates of benign tumors were performed by specialists and what their costs were. Next, we investigated GPs who were informed of the working agreement on FNA in an Interline course in 2011. Statistical analysis was performed to assess whether these GPs requested more FNA in the half year following the course compared to the two half years before the course. Moreover, a telephone survey was conducted on 10 GPs that had followed the course, to assess how they interpret and implement the working agreement on FNA. Results: GPs requested significantly more FNA in the half year after the Interline course than in the two half years before (p < 0,05). The investigated aspirates showed that extra tests were performed in 30.2% of the cases and 83% of the cases concerned benign tumors. In June 2010 to May 2012 an estimated €132.000 was saved on healthcare costs in the diagnosis of benign tumors due to the working agreement of FNA. This shows that FNA of benign tumors can save up to 80% of specialist healthcare costs. GPs in question were well informed on the working agreement of FNA, but there is still room for improvement regarding the GPs indication for FNA. Conclusion: The working agreement of FNA leads to a short-term increase of requests for FNA from GPs. A long term study should be performed to assess long term effects on the GPs requesting behavior. GPs appear to be well informed on the working agreement. However, not all GPs have requested FNA in the investigated period. Additional research is necessary to discover the barriers that prevent GPs from complying to the working agreement. FNA requested by GPs can significantly decrease healthcare costs. Further research is necessary to see whether these results hold on the long term in a larger group of GPs.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Nijholt, I.M. |
| Supervisor name: | Extern begeleider: and Prenger, B. and Locatie onderzoek: MCC-klik Zwolle en Isala klinieken Zwolle |
| 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/47 |
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