Table 3 Concerns surrounding targeted case-finding
Explanation | Example quotation |
|---|---|
3.1 Staff use different terms/approaches to electronic documentation (‘read coding’) within and between practices—so reliability of electronic searches may be poor | Ideally if you were to do case finding you’d do it with a computer system where everybody is using the same read codes and using them regularly. Unfortunately that doesn’t exist in or out of hospital or community care […] read coding is not a very exact science, everybody that does it does things very differently in their own practice so it’s very hard to consistently pick up the right people. We found actually that we were probably just as successful by doing opportunistic screenings than by actually going through the notes and trawling for read codes and people who are presenting with certain things. [GP10102, Male] |
3.2 Short term resource implications (staffing, time and space) | The cost [of targeted case-finding]. […] Someone to search the people, someone to call the people, the nurse then to see them, the healthcare support worker to do the spirometry, etcetera, etcetera, and as I said, it’s difficult. We’re finding it very difficult in our practice at the minute anyway for appointments’ (Nurse Practitioner29216, Female) |
3.3 Long term resource implications (maintaining income) | “I suppose one of the issues […] is the QOF scenario, where if you suddenly code all these people as having COPD, QOF would like them to have an annual review. They’d like them to have the regular spirometry, […] particularly in a small practice like myself, […] even if the initial work had been done in the case-findings, the diagnoses and the education and things, it might be difficult. […] and that’s [QOF generate] the sort of money that pays for the nurses, the annual health checks and things.”[GP33113, Male] |
3.4 Patient candour and uptake of case-finding invitations | “trying to also persuade people to come in for screening can be difficult. […] I get this list and I ring these patients up to try and persuade them to come in, and they make excuses. There are some that are very happy to come in, but there are some that are quite resistant, and I think they worry that you’re going to tell them off because they’re smokers” [Practice Nurse06206, Female] |
