6 Overdiagnosis and overtreatment of infectious diseases in general practice. How and where to break the endless loop?

G. Cordoba, S. H. Arnold, M. Hansen, Julie A Olesen, Maria Louise Veimer, J. Nygaard, L. Bjerrum
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引用次数: 2

Abstract

Background Uncertainty about the origin of symptoms is a frequent challenge faced by health professionals working in general practice. This uncertainty is caused by a complex interaction of factors related to the use and interpretation of diagnostic information triggering overdiagnosis and subsequently overprescription of antibiotics. Unnecessary use of antibiotics is the main driver for development of antimicrobial resistance; hence it is crucial to identify and understand the determinants for overdiagnosis if we are to curb the overprescription of antibiotics in patients seeking care in general practice. Aim To facilitate discussion and advance understanding of the determinants for overdiagnosis in patients seeking care in general practice with suspected respiratory and urinary tract infection. Methodology The didactic methods used in the workshop will be Case-based learning and the fish bowl technique to promote discussion and gradual participation of all attendees. Program: Lecture: Welcome and explanation of key concepts of the diagnostic process in respiratory and urinary tract infections in general practice – 15 min. Clinical cases: this part will be divided into three sessions, in which a clinical case is presented, afterwards the fish–bowl technique is used to facilitate discussion – 60 min. Two moderators will guide the discussion to secure that at least the following three key question are debated for each case: What are the determinants of overdiagnosis or misdiagnosis in this case? Can we find a solution? Which knowledge is missing in order to find a solution to reduce overdiagnosis and the subsequent overtreatment? Cases: Diagnosis of urinary tract infections in the elderly Diagnosis of acute lower respiratory tract infections Diagnosis of sore throat as the main motive of consultation Plenary: Summary and final discussion – 15 min. Outcome After this workshop the participants will be able to identify: The challenges of the diagnostic process in the most common infectious diseases managed in general practice. The drivers for overdiagnosis and subsequent overtreatment. The potential solutions for reducing overdiagnosis.
全科医学中传染病的过度诊断和过度治疗。如何以及在哪里打破这个无休止的循环?
背景:症状起源的不确定性是从事全科医学工作的卫生专业人员经常面临的挑战。这种不确定性是由与诊断信息的使用和解释相关的因素的复杂相互作用造成的,这些因素引发了过度诊断和随后的抗生素过度处方。不必要使用抗生素是产生抗微生物药物耐药性的主要驱动因素;因此,如果我们要遏制在一般实践中寻求护理的患者过度使用抗生素,确定和了解过度诊断的决定因素至关重要。目的促进讨论和提高对在全科就诊的疑似呼吸道和尿路感染患者过度诊断的决定因素的理解。在研讨会中使用的教学方法将是基于案例的学习和鱼缸技术,以促进所有与会者的讨论和逐步参与。课程:讲座:欢迎并讲解全科实践中呼吸道和尿路感染诊断过程的关键概念- 15分钟。临床案例:本部分将分为三节,每节介绍一个临床案例,然后使用鱼缸技巧进行讨论——60分钟。两位主持人将指导讨论,以确保每个病例至少讨论以下三个关键问题:在这种情况下,过度诊断或误诊的决定因素是什么?我们能找到解决办法吗?为了找到减少过度诊断和随后的过度治疗的解决方案,缺少哪些知识?病例:老年尿路感染诊断急性下呼吸道感染诊断以咽喉痛诊断为主要会诊动机全体会议:总结和最后讨论- 15分钟。讲习班结束后,与会者将能够确定:在一般实践中管理的最常见传染病诊断过程的挑战。过度诊断和随后的过度治疗的驱动因素。减少过度诊断的潜在解决方案。
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