Sistema de Salut de Catalunya
Harris, Michael
Frey, Peter
Esteva, Magdalena
Gašparović-Babić, Svjetlana
Marzo-Castillejo, Mercè
Petek, Davorina
Petek-Ster, Marija
Thulesius, Hans
[Harris M] Department for Health, University of Bath, Bath, United Kingdom. [Frey P] Berner Institut für Hausarztmedizin, Universität Bern, Bern, Switzerland. [Esteva M] Atenció Primària de Mallorca, Mallorca, Spain. Fundació Institut d’Investigació Sanitària Illes Balears (idISBA), Palma de Mallorca, Spain. [Gašparović-Babić S] Department for Health Education and Health Promotion, Teaching Institute of Public Health of Primorsko-Goranska County, University of Rijeka, Rijeka, Croatia. [Marzo-Castillejo M] Unitat de Suport a la Recerca, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Direcció d’Atenció Primària Costa de Ponent, Institut Català de la Salut, Cornellà de Llobregat, Spain. [Davorina P, Petek-Ster M] Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. [Thulesius H] Department of Clinical Sciences, Lund University, Lund, Sweden
IDIAP Jordi Gol
2018-06-18T09:37:13Z
2018-06-18T09:37:13Z
2017-03-06
Primary Health Care; Cancer; Diagnosis
Atenció primària de salut; Càncer; Diagnòstic
Atención primaria de salud; Cáncer; Diagnóstico
OBJECTIVE: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. DESIGN: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. SETTING:A total of 14 countries. SUBJECTS:Consensus groups of PCPs. MAIN OUTCOME MEASURES:Probability of initial presentation to a PCP for four clinical vignettes. RESULTS: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r = -0.16, 95% CI -0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = -0.57, 95% CI -0.83 to -0.12; ovary: r = -0.13, 95% CI -0.57 to 0.38; breast r = 0.14, 95% CI -0.36 to 0.58; bowel: r = 0.20, 95% CI -0.31 to 0.62). CONCLUSIONS: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a "PCP-as-gatekeeper" system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival. KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival
English
Càncer - Pacients - Assistència hospitalària; Càncer - Diagnòstic; Càncer - Presa de decisions; HEALTH CARE::Health Services Administration::Patient Care Management::Comprehensive Health Care::Primary Health Care; DISEASES::Neoplasms; Other subheadings::Other subheadings::/diagnosis; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES AND EQUIPMENT::Diagnosis::Clinical Decision-Making; ENFERMEDADES::neoplasias; SALUD PÚBLICA::atención a la salud (salud pública)::niveles de atención a la salud::atención a la salud (salud pública)::atención primaria de la salud; Otros calificadores::Otros calificadores::/diagnóstico; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::toma de decisiones clínicas
Taylor & Francis Open
Scandinavian Journal of Primary Health Care;35(1)
http://www.tandfonline.com/doi/full/10.1080/02813432.2017.1288692
Atribución-NoComercial-SinDerivadas 3.0 España
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
