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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 severitya
Symptom 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/competence
Urgent cases need to go to A&E
Urgent cases can wait for up to two weeks
A specialist will be best placed to treat patients for a specific disorder
Hospital 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 emergency
A TIA is like a heart attack
Possible brain problems require brain scanning before treatment
Personalities and relationships Anxious or concerned patient or GP
Unconcerned or “not wanting to be a nuisance” patient
GP and patient know each other
• GP and patient speak the same language (A&E nurse)
Support tools • Referral forms (GP)
Hospital guidelines/ website
Telephone and fax access to hospital team
GP actions have the “hospital stamp of approval”
Availability of investigations such as carotid ultrasound and heart monitors
Hospital or other transport
Availability of specialist clinics
  1. aAge; blood pressure; weakness or loss of sensation; altered speech; diabetes; previous stroke, TIA or cardiovascular disease; cholesterol; smoking