Preliminary data of the CORap study (Gut Feelings Prognostic Value in Primary Care)

Abstract

Background: GPs have Gut Feelings (GF) during patient visits: a sense of reassurance (SR) when the GP feels that everything about a patient fits or a sense of alarm (SA) when the GP is concerned about a possible adverse outcome. We don't know the prevalence of GF in GPs consultations, how these GFs affect GPs' decisions, or their prognostic value regarding serious diseases or cancer. Research questions: Prevalence of GF in the patients contacts with GPs GF relationship with patient (sociodemographic and clinical) and GP characteristics (sociodemographic and professional). Validity of GF to predict severe disease and cancer. GF relationship with request of tests, investigations, and referrals. Method: Prospective observational, study of diagnosis validity. Patients with a new reason for encounter 48 work days, 26 GPs. Existence of SA/SR determined using the GFQuestionnaire. GPs' variables: age, gender, trainer, rural/urban, years of experience, language. Patients' variables: age, gender, country, language, type of visit, red flag symptoms. Follow-up: Incident diagnosis of severe disease and cancer, requests (investigations, tests, referrals, visits). Results: 287 patients: 80 SA, 191 SR, 6 undetermined. Serious diagnosis: 15 2mo later, 32 6mo later GF prevalence: 281/287: 97.91%. No differences in prevalence of SA/SR regarding: gender (GP,patient), country (patient), language (patient), patient-GP know each other before, language (consultation), type of visit, environment, age (GP). More SA: longer visits, some symptoms (anemia, anorexy, asthenia, weight loss), having at least one red flag symptom, ex-GP trainers. 6mo after SA patients have: more GP visits, lab tests, referrals to specialists, visits to the hospital E.R., primary care procedures (drug administration, wound healing, vital signs checked ). PPV of SR: 98.49% 2 months later, 94.47% 6 months later PPV of SA: 14.63% 2 months later, 24.39& 6 months later Conclusions: Bigger sample size is needed. High prevalence of GF, with little differences regarding studied variables (sample size issue?). Good PPV. Points for discussion: Can GFs help GPs diagnosing rare events like serious diseases and cancer? Can GFs help GPs to pace their decisions, avoiding unnecessary tests for healthy people, and speeding diagnosis for ill people?