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Table 4 Examples of factors influencing the role of the GP and urgency of GP referral. Examples in bold were listed by patients and GPs. (Parentheses indicate factor was only listed by GPs, patients or hospital staff)

From: The role of the GP in managing suspected transient ischaemic attack: a qualitative study

Factors influencing the role of the GP and urgency of GP referral Examples
Clinical characteristics Established risk factors for TIA severityaSymptom un/usual for this patient • Patient is a frequent attender (GP) • Additional illnesses • Frailty or age (GP) • Family history • Day of the week and time of day that symptoms occur (patient) • Duration between symptom onset and GP appointment (GP)
General health beliefs and knowledge General health educational level/competenceUrgent cases need to go to A&EUrgent cases can wait for up to two weeksA specialist will be best placed to treat patients for a specific disorderHospital investigations should precede diagnosis and treatment • Patient choice/demand (GP)
TIA beliefs and knowledge GP and patient knowledge of and belief in national guidelines/awareness campaigns • GP knowledge of local guidelines and referral pathways (GP) • If patient feels well it is not an emergencyA TIA is like a heart attackPossible brain problems require brain scanning before treatment
Personalities and relationships Anxious or concerned patient or GPUnconcerned or “not wanting to be a nuisance” patientGP and patient know each other • GP and patient speak the same language (A&E nurse)
Support tools • Referral forms (GP) • Hospital guidelines/ websiteTelephone and fax access to hospital teamGP actions have the “hospital stamp of approval”Availability of investigations such as carotid ultrasound and heart monitorsHospital or other transportAvailability of specialist clinics
  1. aAge; blood pressure; weakness or loss of sensation; altered speech; diabetes; previous stroke, TIA or cardiovascular disease; cholesterol; smoking