Grunfeld E, Gray A, Mant D, Yudkin P, Adewuyi-Dalton R, Coyle D, Cole D, Stewart J, Fitzpatrick R, Vessey M
Division of Public Health and Primary Health Care, Institute of Health Sciences, University of Oxford, UK.
Br J Cancer. 1999 Mar;79(7-8):1227-33. doi: 10.1038/sj.bjc.6690197.
A randomized controlled trial (RCT) comparing primary-care-centred follow-up of breast cancer patients with the current standard practice of specialist-centred follow-up showed no increase in delay in diagnosing recurrence, and no increase in anxiety or deterioration in health-related quality of life. An economic evaluation of the two schemes of follow-up was conducted concurrent with the RCT Because the RCT found no difference in the primary clinical outcomes, a cost minimization analysis was conducted. Process measures of the quality of care such as frequency and length of visits were superior in primary care. Costs to patients and to the health service were lower in primary care. There was no difference in total costs of diagnostic tests, with particular tests being performed more frequently in primary care than in specialist care. Data are provided on the average frequency and length of visits, and frequency of diagnostic testing for breast cancer patients during the follow-up period.
一项随机对照试验（RCT）比较了以基层医疗为中心对乳腺癌患者的随访与当前以专科医疗为中心的标准随访做法，结果显示诊断复发的延迟没有增加，焦虑也没有增加，与健康相关的生活质量也没有恶化。在进行RCT的同时，对这两种随访方案进行了经济评估。由于RCT发现主要临床结果没有差异，因此进行了成本最小化分析。基层医疗在诸如就诊频率和时长等护理质量的过程指标方面更优。基层医疗中患者和医疗服务的成本更低。诊断测试的总成本没有差异，某些特定测试在基层医疗中的执行频率高于专科医疗。文中提供了随访期间乳腺癌患者的平均就诊频率和时长以及诊断测试频率的数据。
