TY  - GEN
AU  - Guldbrandt,Louise Mahncke
TI  - Implementing Direct Access to Low-Dose Computed Tomography in General Practice-Method, Adaption and Outcome 
SN  - 1932-6203
AV  - W 84.61  
PY  - 2014///
CY  - San Francisco
PB  - Public Library Science
KW  - Primary-Care Patients
KW  - Near East University Article
KW  - Yakın Doğu Üniversitesi Makale
KW  - Lung-Cancer
KW  - Multidisciplinary Sciences
KW  - Diagnosis
N2  - Background: Early detection of lung cancer is crucial as the prognosis depends on the disease stage. Chest radiographs has been the principal diagnostic tool for general practitioners (GPs), but implies a potential risk of false negative results, while computed tomography (CT) has a higher sensitivity. The aim of this study was to describe the implementation of direct access to low-dose CT (LDCT) from general practice.
 Methods: We conducted a cohort study nested in a randomised study. A total of 119 general practices with 266 GPs were randomised into two groups. Intervention GPs were offered direct access to chest LDCT combined with a Continuing Medical Education (CME) meeting on lung cancer diagnosis.
 Results: During a 19-month period, 648 patients were referred to LDCT (0.18/1000 adults on GP list/month). Half of the patients needed further diagnostic work-up, and 15 (2.3%, 95% CI: 1.3-3.8%) of the patients had lung cancer; 60% (95% CI: 32.3-83.7%) in a localised stage. The GP referral rate was 61% higher for CME participants compared to non-participants.
 Conclusion: Of all patients referred to LDCT, 2.3% were diagnosed with lung cancer with a favourable stage distribution. Half of the referred patients needed additional diagnostic work-up. There was an association between participation in CME and use of CT scan. The proportion of cancers diagnosed through the usual fast-track evaluation was 2.2 times higher in the group of CME-participating GPs. The question remains if primary care case-finding with LDCT is a better option for patients having signs and symptoms indicating lung cancer than a screening program. Whether open access to LDCT may provide earlier diagnosis of lung cancer is yet unknown and a randomised trial is required to assess any effect on outcome
UR  - http://library.neu.edu.tr:2048/login?url=http://dx.doi.org/10.1371/journal.pone.0112162 
ER  -