title: Early diagnostic suggestions improve accuracy of family physicians: a randomized controlled trial in Greece.
abstract: BACKGROUND
  In a recent randomized controlled trial, providing UK family physicians with 'early support' (possible diagnoses to consider before any information gathering) was associated with diagnosing hypothetical patients on computer more accurately than control. Another group of physicians, who gathered information, gave a diagnosis, and subsequently received a list of possible diagnoses to consider ('late support'), were no more accurate than control, despite being able to change their initial diagnoses.
  
  
  OBJECTIVE
  To replicate the UK study findings in another country with a different primary health care system.
  
  
  METHODS
  All study materials were translated into Greek. Greek family physicians were randomly allocated to one of three groups: control, early support and late support. Participants saw nine scenarios in random order. After reading some information about the patient and the reason for encounter, they requested more information to diagnose. The main outcome measure was diagnostic accuracy.
  
  
  RESULTS
  One hundred fifty Greek family physicians participated. The early support group was more accurate than control [odds ratio (OR): 1.67 (1.21-2.31)]. Like their UK counterparts, physicians in the late support group rarely changed their initial diagnoses after receiving support. The pooled OR for the early support versus control comparison from the meta-analysis of the UK and Greek data was 1.40 (1.13-1.67).
  
  
  CONCLUSIONS
  Using the same methodology with a different sample of family physicians in a different country, we found that suggesting diagnoses to consider before physicians start gathering information was associated with more accurate diagnoses. This constitutes further supportive evidence of a generalizable effect of early support.
authors: Department of Primary Care & Public Health Sciences, King's College London, London, UK and olga.kostopoulou@kcl.ac.uk.
authors: Olga
authors: O
authors: Kostopoulou
authors: Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece.
authors: Christos
authors: C
authors: Lionis
authors: Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece.
authors: Agapi
authors: A
authors: Angelaki
authors: Department of Primary Care & Public Health Sciences, King's College London, London, UK and.
authors: Salma
authors: S
authors: Ayis
authors: Department of Primary Care & Public Health Sciences, King's College London, London, UK and.
authors: Stevo
authors: S
authors: Durbaba
authors: Department of Primary Care & Public Health Sciences, King's College London, London, UK and.
authors: Brendan C
authors: BC
authors: Delaney
mesh_terms: D003431:Cross-Cultural Comparison; D003657:Decision Making; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D005260:Female; D006115:Greece; D006801:Humans; D020407:Internet; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D006113:United Kingdom
keywords: Decision making; decision support systems; diagnosis; diagnostic error.