When a GP needs a specialist’s input with the care of a patient, one option is to use ‘Advice and Guidance’. Advice and Guidance is an electronic way for a GP to ask a clinical question and a specialist responds, usually within a few days. The response may be to send the patient to see a specialist (referral), try a treatment, or do a test. Advice and Guidance was introduced to speed up access to a specialist opinion and cut waiting times for outpatient care. There are few studies telling us whether Advice and Guidance has a better or worse effect on patient care versus usual referrals.
The aim of this feasibility study is to determine (i) how often Advice and Guidance is used by GPs prior to a condition being diagnosed, and (ii) summarise the time between Advice and Guidance and diagnosis records.
We will use a national database of anonymous GP records to find patients who have been newly diagnosed with systemic lupus erythematosus (SLE) between 01/01/2015 and 31/12/2022. We will determine how many patients have a request for Advice and Guidance and/or a routine referral in their notes in the 3 years prior to diagnosis. We will calculate the time to diagnosis of SLE from a first request for Advice and Guidance or routine referral.
When a GP needs a specialist’s input with the care of a patient, one option is to use ‘Advice and Guidance’. Advice and Guidance is an electronic way for a GP to ask a clinical question and a specialist responds, usually within a few days. The response may be to refer the patient to secondary care, initiate a new treatment, or do an investigation. Advice and Guidance was introduced to speed up access to a specialist opinion and cut waiting times for outpatient care. There are few studies telling us whether Advice and Guidance has a better or worse effect on patient care versus usual referrals.
The aim of this feasibility study is to determine (i) how often Advice and Guidance is used by GPs prior to a condition being diagnosed, and (ii) the time between Advice and Guidance and diagnosis records.
We will use the Clinical Practice Research Datalink (CPRD) Aurum database of de-identified electronic primary care records to determine the number of individuals newly diagnosed with systemic lupus erythematosus (SLE) between 01/01/2015 and 31/12/2022. We will determine the proportion of individuals with (i) Advice and Guidance only, (ii) routine referral only, (iii) both Advice and Guidance and routine referral, and (iv) neither Advice and Guidance and routine referral recorded in their notes in the 3 years prior to diagnosis. To determine the most appropriate prior registration period, we will stratify the proportion of patients recorded with Advice and Guidance and/or routine referral into those with records in the 0-24 months and 25-36 months prior to SLE diagnosis. We will also calculate the time to diagnosis of SLE from a first request for Advice and Guidance or routine referral.
Number of patients recorded with incident SLE diagnosis and:
(i) a routine referral recorded in previous 0-24 months and previous 25-36 months;
(ii) Advice and Guidance recorded in previous 0-24 months and previous 25-36 months; and
(iii) both an Advice and Guidance and routine referral code recorded in the previous 0-24 months and previous 25-36 months.
We will also calculate the median time to diagnosis from a first request for Advice and Guidance or routine referral within 36 months prior to diagnosis.
Claire Burton - Chief Investigator - Keele University
Kayleigh Mason - Corresponding Applicant - Keele University
James Bailey - Collaborator - Keele University
Kelvin Jordan - Collaborator - Keele University
Victoria Welsh - Collaborator - Keele University