Mphe 5203 Module Characteristics Independent Case Study

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Introduction

Aim and objectives

Aim

To improve Deep Vein Thrombosis [DVT] detection procedure through D-dimer Machine in primary care settings.

Objectives

1. To critically analyse the Diagnostic Accuracy of D-Dimer Testing within primary care settings.
2. To critically evaluate the systematic barriers in effective DVT detection in primary care settings.
3. To critically examine the influence of D-Dimer testing on patient health outcomes in DVT diagnosis
4. To recommend comprehensive standards for DVT screening through D-Dimer levels within primary care settings.

Detailed evaluation of objectives

1^st objective will focus on critically assessing the specificity and sensitivity of D-Dimer testing used within primary care settings for DVT detection. The goal is to analyse existing literature for assessing predictive validity and this further leads to improve clinical decision making. By focusing on the ways in which D-Dimer levels correlating with DVT cases, the study is aiming to refine diagnostic protocols embedded in primary care settings.

Samples and reference materials assist students in enhancing assignment structure and academic performance. As a trusted assignment helper in UK, we ensure originality and quality. The MPHE 5203 Module Characteristics Independent Case Study covers D-dimer testing accuracy, DVT detection barriers, patient health outcomes and standardised screening protocols in primary care. For learning use only.

2^nd objective seeks to explore different factors hindering optimal DVT detection within primary care setting. Through reviewing peer reviewed articles and authentic sources this objective aims to delineate research and knowledge gap, workflow ineffectiveness and resource limitations. It is important to understand these barriers as this will support in formulating targeted interventions streamlining DVT diagnosis and patient safety.

3^rd objective will examine correlation exist between D-Dimer testing and management of DVT cases within primary care settings. The focus would be implied on examining literature related to patient case outcomes, patient safety and complications. The study will identify whether integration of D-dimer testing in routine practices ensuring improved patient safety and decreased incidence of thromboembolic cases.

4^th objective is aiming to develop an evidence-based standardised protocols for DVT diagnosis and screening which integrates D-Dimer result in primary settings. This protocol will align with incorporation of the clinical guidelines for guiding healthcare providers in detecting and making accurate diagnostic decision. Thus, this leads to promote evidence-based management practices for suspecting DVT cases.

Rationale

Deep Vein Thrombosis [DVT] expounded as an obstructive disease followed by hindering venous reflux mechanism; prevalence of DVT and its potential complications including pulmonary embolism (PE) increasing to greater extent (Kearon et al, 2022). This is a serious condition in which blood clot forms within a deep vein, particularly, in legs arms and pelvis. DVT found to be a significant public health concern leading to mortality and morbidity among patients. From the current trends it is evident that there is concerning gap in early detection of DVT within primary care settings, this is primarily due to over reliance on inadequate and inappropriate diagnostic method and diverse level of clinical expertise (Price, Fay and Hopstaken, 2021). However, D-Dimer testing is emerging in healthcare context as a valuable biomarker, this is guiding clinician in ruling out DVT among targeted population. Whilst, implementation of D-Dimer testing in primary care settings remains inadequate and inconsistent and this is leading to persistent diagnostic errors, increased healthcare cost and delayed treatment (Cosmi et al, 2023). Despite varied benefits of D-Dimer testing, negative predictive values are upholding the notion of criticism. Existing research revealing that there is ambiguity in implying, interpreting and integrating D-Dimer testing in care procedures.

Moreover, primary care practitioner lacking in professionalised expertise and training regarding distinction of DVT diagnosis, this is significantly contributing in misdiagnosis and underdiagnosis (Panpikoon et al, 2022). Thereby, contextual focus requires to be implied on enhancing the effectiveness of DVT detection via systematic evaluation, implication and enhancement of D-Dimer testing procedure proves to be pivotal (Feng et al, 2023). It is essential to address systematic barriers, further standardised protocols result in optimising diagnostic procedure and decreases the potential risk comprises with post-thrombotic syndrome and enhances patient safety and quality of care within primary care settings (Liu et al, 2022). The anticipated findings of the study will contribute in determining evidence-based practices regarding DVT management in primary settings; through articulating diagnostic capacity of D-Dimer testing and addressing potential operational issues, research will inform clinical practices and bridges existing gape in DVT diagnosis. Hence, the motive of the independent study is to foster a safe and secure healthcare environment for patients who are at the prevalent risk of thromboembolic events

Methods Of Investigation

The researcher will prefer “Review of Literature” in current study context; review of literature refers to comprehensive and critical analysis of existing research and authentic sources on a specific topic (Lim Kumar and Ali, 2022). Analyst will review existing literature as it supports in demonstrating understanding related to current research landscape regarding research context. Furthermore, it supports in identification of gap within primary care setting with regards to inclusion of D-dimer testing. Review of literature enable researcher to adopt a critical approach aligning with evaluating strengths and weaknesses and consequently, connection between different studies would be identified. In current study context, researcher has followed below mentioned literature search strategy

Data collection and Analysis

In order to collect data, researcher preferred secondary method and accordingly peer-reviewed articles and authentic database were reviewed. The rationale behind preferring secondary method aligns with evaluation of existing evidences and it is further cost effective and time effective method (Van Dinter et al, 2021). Furthermore, in order to analyse the information scholar approached thematic analysis and consequently, different themes were developed for presenting findings. Thematic analysis is an effective approach for developing detailed understanding regarding specific topic; through different themes detailed evaluation can be done and therefore, analyst has approached thematic method (Hazari, 2024).

Key words

Key words are determined as key confrontations entered in database for searching relevant articles. It is important to select significant key words as this supports in identification of appropriate information (Hazari, 2024). The researcher has used varied keywords such as “Deep Vein Thrombosis”, “DVT”, “D-Dimer”, “Detection”, “Procedure”, “Primary Care”, “Settings”, “Barriers”, “Testing”, ‘Diagnostic”, “Accuracy”, “Patient”, “Health”, “Outcomes”, “Impacts”, “Screening” and “Diagnosis”. These key words have been used for identifying relevant peer reviewed articles. All of these key domains relate with research context and therefore, analyst has used these key words in current research context. By using these confrontations, authentic peer-reviewed articles were witnessed and consequently, literature review was conducted.

Inclusion and exclusion criteria

Inclusion and Exclusion criteria determines about key components which are essential to be included and excluded from the study (Gartlehner et al, 2022). In order to select authentic articles inclusion and exclusion criteria has been followed by researcher-

Table 1-Inclusion and Exclusion Criteria

Inclusion Criteria	Exclusion Criteria
Those articles which are published after 2019 were involved in the study. Those studies which were focusing on DVT and D-Dimer testing were considered in the study. Papers that were published in English language was considered. Only peer-reviewed articles were selected and considered in the study.	Studies which were published before 2019 was discarded from the study. Articles which were not focusing on DVT and D-dimer testing were excluded from the research. Papers which were published in other than English language was not included. Articles which were not peer reviewed was discarded from the study.

Thus, above mentioned inclusion and exclusion criteria was followed by researcher and accordingly, high-quality articles were approached for developing insights and conducting literature in study context.

Database

Table 2-Database used in study

PubMed	PubMed is one of the trustable and authentic sources that comprised with wider collection of healthcare literature. It has free access and further, MeSH term feature makes it easy to access relevant articles (Kyoung and Kim, 2021). Thereby, the analyst has selected this database and accordingly issues comprised with D-Dimer and DVT detection were analysed and consequently, findings has been developed.
BioMed	BioMed is curated with peer-reviewed articles; this database is specifically providing access to reliable and authentic medical literature (Mazov and Gureyev, 2023). Hence, by approaching this database, researcher has gathered quality information regarding research context.
MEDLINE	MEDLINE is an authoritative source; it permits in accessing quality articles and provide detailed information regarding healthcare and medical contexts (Kyoung and Kim, 2021). The current research complies with improving healthcare services in primary care settings. Thereby, researcher preferred this database for reviewing wider literature in research context.

The above-mentioned databases are approached by researcher for gaining detailed insights related to DVT detection, issues and implication of D-Dimer testing. Furthermore, Google Scholar was used for searching relevant articles and consequently, literature review has been conducted. Moreover, researcher preferred authentic websites such as NHS and PHE for gaining authentic information.

Mphe 5203 Module Characteristics Independent Case Study

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Ethics

Ethics are expounded as an essential aspect in research procedure; it specifies that research has been conducted in ethical manner (Mishra and Alok, 2022). The scholar has followed all mandatory ethics and accordingly, activities were undertaken. The prior focus was implied on maintaining academic integrity and consequently, authentic references were used and information has been paraphrased. Moreover, authentic articles were selected by following a literature search strategy and accordingly, quality information is included in the study.

Study Framework- Review Of Literature

From the existing literature it is witnessed that DVT profounds significant public health issue and further contributing in increasing the mortality and morbidity rate among patients. It has been evident that progression in pulmonary embolism leading to increase the cases of DVT (Schulman, Konstantinides and Tang, 2020). Diagnosing DVT is essential; the diagnosis procedure complies with undertaking physical exam. There are different tests conducted for detection of DVT such as Duplex ultrasound, venography, D-dimer test and Magnetic resonance imaging [MRI] Scan (Schulman, Konstantinides and Tang, 2020). In primary care settings, there is lack of robust strategy related to DVT detection that is significantly impacting patient outcomes. The current review will emphasise on critically examining D-Dimer testing and its role in DVT diagnostic procedure. Prior focus implied on identification of the existing loopholes comprehending with DVT detection. Consequently, evidence-based recommendations for enhancing future practices will be provided.

Theme 1- Issues comprising with DVT detection, D-Dimer testing and its implication in primary care settings

In the study of Ordieres-Ortega et al, (2020) it was evident that professional practices complying with DVT detection is further instilled with varied complexities; diverse variance in clinical expertise and knowledge among healthcare providers within primary care is acting as a significant barrier. Existing literature underpinning important criticism adhering with lack of training and awareness regarding DVT diagnostic protocols and therefore, it is further hindering the abilities of healthcare providers in accurately detecting diagnosis. Further, it is evident that training is pivotal for detecting DVT particularly, in context of ultrasound proficiency, operator dependence, assuring proper compression and differentiating DVT from other conditions. Lack of expertise in this area often misguide healthcare professionals which develops drastic influence on patient outcomes. However, study of Chopard, Albertsen and Piazza, (2020) elucidated that general practitioner often struggles with integration of D-dimer results and this is leading to ineffectiveness in diagnosis procedure and further impacting treatment procedure. Despite effective results, qualitative approach of D-dimer test demonstrating decreased diagnostic sensitivity in comparison to quantitative D-dimer test. Inappropriate integration of D-dimer test leading to diverse errors and causing clinical complexities; likelihood of detecting wrong positive results is often high. Whilst, this is developing requirement for conducting another test and leading to increase in cost and often consumes time of practitioner.

The perceived requirement based on advanced imaging techniques displacing D-dimer testing and creating wider complexities for practitioners. Whilst, there is no doubt in depicting that D-dimer test provides significant contribution in DVT detection. Al-Khafaji and Schierbeck, (2020) elucidated that DVT detection is essential it is one of topmost concern leading to higher mortality and morbidity rates among hospitalised patients. D-dimer test is utilised for undertaking initial screening test in emergency department for witnessing the symptoms of venous thromboembolism (VTE). Furthermore, D-dimer test is evident in patients suffering from DVT. However, Cosmi et al, (2023) stated that before proceeding with this test it is important to assess and analyse the VTE clinical probability in patient. In D-dimer procedure the dependence on imaging leads to delays in procedure of diagnosing and treatment and further increases healthcare cost that influences patient outcomes in adverse manner. Practitioners in primary care settings are not aware about the contextual domains aligned with D-dimer testing and this is developing potential complications in diagnosis procedure.

Iwuji et al, (2021) study upholding the criticism aligns with D-dimer machine; the study revealed that D-dimer testing provides poor significance and specificity which further misguide practitioners and provides false positive results. Particularly, in those individuals who are experiencing symptoms from longer duration. Whilst, positive aspect of the test is that it has high sensitivity and thereby, this proves to be effective in identification of DVT and its presence in patient. Thereby, this test is widely used in healthcare settings, findings has shown that elevated d-dimer levels can arise in certain condition that involves trauma, cancer, pregnancy and surgery; wrong levels might not be elevated in all DVT cases specifically when clot is small and symptoms has been persisting for long time. It is essential for primary care practitioners to understand the use of d-dimer in DVT detection as this contributes in adopting an evidence-based approach and further lead to enhance patient wellbeing and outcomes. D-dimer is effective for individuals with low clinical suspicion instead of confirming the diagnosis and therefore, test should be used for this purpose. Gkana et al, (2022) specified that in present NICE guidelines does not suggesting about using Point-of-care D-dimer test as an alternat protocol of laboratory D-dimer tests, hence, considering this guideline laboratory tests are preferred. (NICE, 2024). Whilst, due to varied complexities as specified in above section such as lacking in specificity, false positives, different d-dimer levels and lack of standardised unit measure creating barrier in its implication. Furthermore, primary care practitioners are not aware about the solution that addresses such complications.

From the above presented information this can be specified that, diagnostic accuracy of D-dimer test possess sensitivity and thereby, this proves to be effective in identification of blood clot. However, it is lacking in specificity due to different levels and thereby, it leads to false-positive results. Further, the test is lacking in accurate identification in those patients who does not have blood clot. Contextual information significantly specifying about the issue aligning with DVT detection and D-dimer testing; hence, there is need to specify focus on this area so that appropriate implication can be done and effective outcomes could be gained.

Theme 2- Critically examining the impact of D-dimer testing on patient health outcomes in Diagnosing DVT

McCormack et al, (2020) articulated that DVT diagnosis is authoritative for vindicating potential complications in long-run particularly, for chronic venous insufficiency, pulmonary embolism; not focusing on this aspect can often lead to death. D-dimer test emerging in this context and they are identified as an important domain in diagnosis of DVT; the role of D-dimer level persisting in clinical diagnosis and further revealing about the persistent influence on patient outcomes. Patients with the susception of DVT are referred in ED so their initial evaluation can be done whilst, management of such patient is a crucial approach that requires a robust evidence-based strategy and expertise for tackling the situation. D-dimer is priorly elevated in presence of DVT, there are varied studies demonstrating that negative test results can significantly rule out DVT procedure. This is further result in decrease in unnecessary study imaging that comprised with potential risk of radiation exposure.

Whereas, Duffett, (2022) revealed that patients suffering from any pathological or physiological issues have higher audacity to increase in their D-dimer levels whilst, patient suffering from acute DVT for them D-dimer levels often fail to recognise the clot. Due to this reason, study has demonstrated that d-dimer test level persists with higher sensitivity and lower specificity in diagnosing acute conditions. Careful consideration is needed to undertake DVT diagnosis careful clinical assessment provided authentic results and detects DVT in patient. Overusing and misusing D-dimer test complies with negative consequence for both healthcare and patient. Wrong results impact patient health outcomes in drastic manner whilst, consistent using of dimer-levels increase in healthcare cost. The presented facts revealing that overuse of d-dimer levels creating significant complexities on patients and healthcare settings by upsurging the cost of healthcare settings and leading to adverse patient health outcomes. Accuracy in diagnosis is needed for taking preventive measures however, fluctuation in d-dimer levels developing complications and decreased specificity misguiding the results.

Rinde, (2023) findings depicted assays found to be differ in antibody and data; some prevalent to qualitative while some are quantitative. Thereby, d-dimer assays depend upon different factors comprises with time, complexity, sensitivity, specificity and cost; thus, accuracy of test determines through the cut-off values. This range concerned with specificity and sensitivity and this often becomes different when it is compared to between different assay; primarily, cut-off points are determined as per d-dimer testing. From these tests, it is evident that diverse range of specificities and sensitivities are witnessed within dissimilar D-dimer assays. Variations among different D-dimer assays underpinning the major criticism and thereby, result from one assay should not induced to an alternative. Hence, different range persisting in different assay leading to develop complication in undertaking accurate diagnosis of DVT; fluctuation in sensitivity and specificity of test and not able to identify blood clot due to different assay makes it difficult for practitioners to include these tests in detection of DVT.

However, Innocenti et al, (2021) elucidated that incorporation of D-dimer in primary care settings improving patient outcomes through prompting diagnosis along with the accurate treatment of DVT. This is further reducing unnecessary burden comprised with anticoagulation therapies; d-dimer testing leading to rapid and targeted diagnosis and thereby, reduce unnecessary burden. Hence, this is significantly leading to reduce healthcare burden and cost which makes it an effective and subsequent options for primary care settings. This test leads to decrease requirement of further tests, in low-risk patient a negative test ruling out DVT and further reducing expensive imagining method such as CT scans and ultrasound. Furthermore, D-dimer tests approach is easy to imply and positive test result signifies that patient has blood clotting problem; timely detection supports in implementing adequate interventional strategies and enhances patient health outcomes.

The research of Gotta et al, (2023) revealed one significant issue comprised with D-dimer testing is its use in emergency medicine; particularly, when no urgent diagnostic imaging is available within setting. Different range in assay can misguide practitioner and it results in impacting the accuracy of diagnosis. Despite varied benefits there are significant point of caution identified in terms of using D-dimer test. Qualitative test demonstrating low diagnostic accuracy while comparing with quantitative assay. Physicians working in ED must possess adequate knowledge so they can optimally use D-dimer test and further it helps in detection of DVT. Thus, it is crucial for clinician that they must have awareness about the complications and barriers persisting with D-dimer testing. Inappropriate implication of testing creating clinical complication and errors in accuracy of diagnosis thereby, appropriate implication is required. Adequate knowledge regarding ranging of values and implication of D-dimer levels supports in gaining accurate test results and further enable practitioners in terms of diagnosing DVT.

Nevertheless, Ordieres-Ortega et al, (2020) articulated that D-dimer testing requires to be safety use in ED in order to rule out one acute VTE this can be DVT or PE. This test is secure and reliable in identification of one diagnosis and often provides immediate results when used appropriately. The heterogeneity of method making it a complex procedure and therefore, before finalising diagnosis D-dimer test accuracy must be assessed in careful manner so that accurate identification can be done and further treatment can be implied. Furthermore, it is essential to organise training for physicians in primary care settings so they become able to learn about complications and fluctuations in D-dimer levels and its implication with varied assay. Expertise is needed for undertaking this test and identifying diagnosis; before implying d-dimer testing in setting training should be organised and prior focus needs to be implemented on enhancing knowledge, skills and expertise of clinicians.

Theme 3- Importance of including D-dimer testing in primary care settings

Di Minno et al, (2021) stated that use of D-dimer testing is significantly not prohibited to ED or any specialised care; its integration in primary settings underpinning important aspects related to enhancing management of patients. From the literature it is evident that primary care providers act as frontline service providers as they primarily contact with service users. Thereby, they play essential role in early detection and diagnosis of DVT; by developing significant understanding regarding the sensitivity and specificity levels healthcare providers can effectively imply diagnostic procedure which is essential for ensuring support to patient.

D-dimer expounded as an effective procedure for identification of blood clot and breading down the process and accordingly, it measures and analysis blood sample of patient. Primary care provider should be aware about the specificity and sensitivity in D-dimer levels as it comprehends with different assay. Understanding the potential range of d-dimer levels is crucial; normal d-dimer should be less than 0.50 while, positive is equal to 0.50 or it is further greater than this (Schafer et al, 2022). Incorporation of D-dimer testing in primary care setting supports primary care provider to detect DVT and timey action can be taken for reducing potential complication for patients. Furthermore, this test providing further benefits related to decreasing cost of production in healthcare setting which often boosts efficacy of the services.

On the other hand, Cosmi et al, (2023) highlighted the significance of including D-dimer test in primary care settings; by gaining essential and significant training in this context service provider can effectively detect blood clot and potential complication of DVT in patient. At present, many physicians are not expert in detection of DVT and as a result, patient needs to wait, in case of emergency as well there is lack of management. Specifically, individuals belong from BAME background faces disparities in receiving services in primary care; they have lack of access towards healthcare services and due to huge demand and lack of expertise in providers they are not able to gain advantage of services. Such scenarios specifies that a robust approach is required and each service provider in primary setting should be trained enough so they can tackle the concerns of individuals belonging from diverse background (Cosmi et al, 2023). Hence, incorporation of D-dimer testing in primary care settings led to organise training and educational workshops for service providers and accordingly, they will be able to attained patients from diverse background. This results in reducing the load on senior service providers and further improves the procedure of DVT detection by including d-dimer machines.

The research of Balato et al, (2022) specified that incorporation of D-dimer testing within routine practices supports practitioner in assessing individuals presenting with swelling in leg or suffering from severe pain. The workload on seniors could be reduced and further effective management of healthcare practices can be undertaken. The prior benefits of using D-dimer testing within primary settings entitled with potential of implementing timely intervention. There are varied patients in primary care settings who faces persistent delay in their diagnosis procedure and this is significantly due to referral procedure as a result, they are not able to receive immediate evaluation. Thus, implementation of D-dimer testing enables patients to receive accurate results on time and consequently, they would be able to initiate anticoagulation therapy in case if it is required. The early detection and treatment specifically decrease the likelihood of severe complications in patients.

Whereas, study of Rinde et al, (2020) revealed that integration of D-dimer testing alleviates the consistent burden on secondary care services and further promotes optimum utilisation of available healthcare resources at primary level. There is need to empower service provider in primary care settings so they become able to use advancement tool for DVT detection. These conditions can effectively manage within outpatient setting; whilst, consistent referrals delay the procedure; implication of D-dimer testing ultimately saves healthcare resource, time and cost and consequently, resource management would be undertaken in significant manner. From social and economic perspective; inclusion of D-Dimer machine and testing in primary care serring complies with varied benefits; in economic context, it supports in using healthcare resources in optimal manner and further enhances the practices within setting (Rinde et al, 2020). Further, dependency on secondary services for detection leads to reduce and timely detection takes place within primary care settings. Thus, it supports in reducing healthcare cost and further optimum utilisation of resources could be done.

In social context, equal access to healthcare services can be ensured to all individuals belonging from diverse background. Due to lack of expertise in primary care providers many individuals from BAME backgrounds are not able to access services from secondary care (Pannu et al, 2020). By using D-dimer test, service providers can detect potential complication in individuals and accordingly, appropriate intervention could be suggested to them. People from BAME background will be able to receive quality care and this results in enhancing their health outcomes and further reduces the risk for further severe complications.

However, Kearon et al, (2022) there is need to identify the systematic barriers as this can lead to impact whole procedure in negative manner; incorporation of D-dimer testing in primary care setting persist with different challenges. These issues comply with implementation of strict guidelines with regards to using of diagnostic tool and implication of testing method in existing clinical practices. It is essential to focus on overcoming these substantial barriers so clinical practices can be supported. By implementing a collaborative approach among healthcare leaders and policymakers a pragmatic framework can be implied that enables in undertaking effective utilisation of D-dimer testing.

Theme 4- Evaluation of practical complication

Wauthier et al, (2023) elucidated that integration of D-dimer testing for diagnosing DVT ensuring subsequent benefits; however, there are certain practical implication in this context which leads to impact whole procedure. Therefore, it is important to identify those barriers and consequently, they must be addressed. Focusing on these issues are essential for optimising patient safety and ensuring high-quality healthcare delivery. The topmost issue comprised with the likelihood for false-positive results and this is primarily due to confounding components which elevate D-Dimer levels. Patients who suffered from surgical process or infectious inflammatory disease presents with increase D-dimer levels that is often not relates with any thrombotic events. Furthermore, in pregnant women, cancer patient and elderly patients D-Dimer levels are high. As a result, false positive outcomes misguide practitioners and unnecessary suggestions related to initiation of anticoagulation therapy and diagnostic image is given to patients (Cosmi et al, 2023). In such case, unnecessary anticoagulation results in complication such as bleeding and develops threat for patient health. Therefore, it is important that clinicians must possess expertise and increased sense of clinical judgment while implying D-dimer testing. They should be aware of the cause that can lead to show higher D-dimer levels within patients. The broader view of patient’s clinical picture requires to be developed so that consequences identified in detailed manner and appropriate clinical decision could be implied.

However, Rinde et al, (2020) stated that overdependence on D-dimer test results in decreasing focus throughout clinical examination procedure. In case, clinicians show over reliance on D-dimer results without considering holistic needs of patients then there are chances that clinicians might overlook co-existing concern or other issues of patient. This issue specifying that there is need to implement an integrative clinical procedure which motivates clinician to undertake appropriate clinical assessment while considering the needs and requirements of patient. Thus, focus requires to be implied on adopting holistic approach and consequently, steps require to be undertaken. Di Minno et al, (2021) specified about another important concern; there are significant challenges faced in standardised D-dimer testing methods within different laboratories (Franchini et al, 2023). It has been witnessed that variation in Assay methods creating discrepancies within test outcomes. Hence, this is hindering the capabilities of undertaking evidence-based decision in primary setting. As specified in above themes that difference in D-dimer levels due to different assay misguide clinicians and further impacts their decision-making procedure. In order to address these variations, it is important to imply standardised protocols within primary care settings; the prior emphasis requires to be initiate on accessing reliable laboratory services that provides high-quality D-dimer test results and further maintains consistency in the result.

Koch et al, (2021) depicted that depending on negative D-dimer test results particularly, in context of low-risk population results in ruling out DVT, often without considering adequate follow up. Thus, this procedure comprehends with risk and further result is missed diagnosis and ignores potential underlying factors that contributes in severe thromboembolic concerns. Therefore, it is important to undertake educational initiatives in primary care settings as this results in fostering detailed understanding in physicians regarding the systematic barriers persisting with D-Dimer testing (Koch et al, 2021). Hence, this further encourage clinicians to become attentive; further it guides them in considering all important factors impacting patient wellbeing along with reducing overdependency on laboratory results.

From the analysis it has been witnessed that practical challenges of D-Dimer testing have potential to impact patient wellbeing. Wrong detection due to false positive results creates drastic impact on patient health outcomes. At a particular point of time this develops stress in patient and further interventions are undertaken for them. On the other hand, due to variation is assay there is lack of standardisation in procedure that further misguide results. In many cases, false negative outcomes develop severe risk for patients in long run and increases the likelihood of chronic thrombosis events.

Theme 5- Implication of comprehensive standards for DVT screening

In the study of Parpia et al, (2020) it has been analysed that it is important to establish comprehensive standards for undertaking DVT screening while using D-Dimer levels. These standards are crucial for maintaining quality and consistency in clinical evidence so that evidence-based decision could be taken and subsequently, patient safety and health outcomes can be improved. Implementation of comprehensive guidelines is important as this significantly guide primary care providers about D-dimer testing and its implication. For different clinical scenarios there are different criteria should be specified. For example- if a patient has low-risk outcome from D-Dimer screening then in such case clinical decision should comply with undertaking well scores or revised Geneva score (Fronas et al, 2020). Patient safety should be put at the forefront of care services and accordingly targeted approach in identification of DVT cases requires to be implied.

Fronas et al, (2020) depicted that; integration of D-dimer testing with existing care supports in establishment of checkpoints for undertaking clinical assessment and determining interventions. There is need to adopt a robust cohesive mechanism that underpins corelation existing between laboratory results and clinical evidences. Thus, such guidelines support in streamlining practices and improves collaboration in primary care settings. Furthermore, emphasis should be implied on adopting effective communication mechanism within Multidisciplinary teams; this results in fostering and driving improvements and assures patient safety. In case, primary care provider has doubt with D-dimer results then then can significantly collaborate with other professionals in multi-disciplinary team and accordingly further action can be taken.

As per NMC it is essential that professional should act in accordance with their skills, abilities and knowledge; acting with competence supports in taking adequate decision that promotes patient safety (NMC,2024). Similarly, in using D-dimer testing it is pivotal for primary care providers to take actions with their competence and further guidance should be taken with professionals from multidisciplinary team. Bhatt et al, (2020) stated that comprehensive standard entitled with DVT screening should be comprised with organising educational programmes and training for improving knowledge, skills and competencies of primary care practitioners and providers. The training initiative must emphasise on interpretation of D-dimer test outcomes; this leads to enhance the capability of clinicians in utilising test results in adequate manner. Focusing on consistent professional development program enhance expertise of service providers in DVT diagnosis. Such initiative assures that practitioners are complying with evidence-based guidelines and practices. Therefore, it is important to organise training and educational programme within primary care settings as this results in providing effective results.

Bhatt et al, (2020) emphasised on the implication of D-dimer testing in primary healthcare setting; improvement in DVT detection significantly results in reducing healthcare costs. Unnecessary expenses comprised with referrals, imaging and anticoagulation management can be managed and optimum utilisation of the resources could be undertaken. Hence, there will be decline in thrombosis events that stemmed from misdiagnosis; this leads to improve quality indicators within healthcare system and reinforce effective strategies regarding DVT detection (Bhatt et al, 2020). Thus, by enhancing competence and skills of clinicians effective DVT detection management through D-dimer testing can be done and consequently, patient safety could be assured. Hence, there is need to imply robust mechanism in primary care settings as this supports in improvement of DVT detection through D-Dimer testing and assures patient safety. The knowledge of primary care providers can be enhanced and healthcare cost could be managed.

Conclusion And Recommendations

Conclusively; this can be said that D-Dimer testing provides significant support to clinicians in detecting DVT; whilst, it is important to develop awareness in primary care providers regarding the implication of D-dimer testing. Lack of knowledge in this area can create patient in adverse manner, missing diagnosis due to low-risk feature creates likelihood of severe complication in patient. Furthermore, false positive results due to higher D-dimer levels in certain cases such as pregnancy, infectious disease and post-surgery misguide clinicians and they further suggest unnecessary treatment to patients that develops complications. D-dimer test often proven effective as it reduces healthcare cost by undertaking diagnosis procedure in rapid manner. However, adequate knowledge regarding variation in assay and concepts of high sensitivity and low specificity should be gained by primary care providers only afterwards, appropriate detection of DVT can be undertaken. Below mentioned recommendations should be implied in primary care settings for improving DVT detection through D-dimer testing.

Education and Training Initiative

In primary care settings, training should be organised and focus must be implied on enhancing knowledge of clinicians. The understanding regarding interpretation of D-dimer test findings and exceptions in which test can show false negative and false positive results should be developed by primary care providers (Setiawan et al, 2020). It enables them to undertake accurate diagnosis of DVT in patients and further ensures patient safety.

Follow up and monitoring

In case a patient is presented with positive test or high clinical probability, in such situation pre-condition must be examined (Kearon et al, 2022). There might be possibility that higher D-dimer levels are due to other factors and by examining pre-existing conditions adequate cause can be witnessed.

Standard Protocols

The standard protocols should be undertaken; in case the pre-test probability of VTE shows low then, Point-of-Care D-dimer test requires to be considered. It supports in undertaking adequate clinical decisions (Cosmi et al, 2023). Whereas, in case of positive outcome, further test involving ultrasound for DVT or Ventilation-Perfusion Scan should be considered. In context of different clinical scenarios, different criteria should be specified so that clinicians become aware about procedure.

Communication Mechanism

It is recommended to improve communication within MDT as this promotes knowledge and competence in physician and further supports them in taking significant decisions in crucial situations. In case, primary care providers face issues in interpreting D-Dimer test results then they can take guidance from experts within MDT (Kearon et al, 2022). Thereby, it is significant to developed effective communication mechanism as this contributes in implanting effective decision within clinical settings.

Hence, by following above mentioned recommendation effective implementation of D-Dimer testing in primary settings can be done and accordingly, DVT detection can be enhanced.

References

Books and Journals

• Al-Khafaji, R.A. and Schierbeck, L., 2020. Deep venous thrombosis in a patient with a moderate Pretest Probability and a negative D-Dimer test: a review of the Diagnostic algorithms. Journal of Blood Medicine, pp.173-184.
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• Online
• NICE, 2024. Online. Available through < https://www.nice.org.uk/guidance/ng158>
• NMC,2024. Online. Available through. < https://www.nmc.org.uk/>