Gorey Kevin M, Luginaah Isaac N, Hamm Caroline, Balagurusamy Madhan, Holowaty Eric J
School of Social Work, University of Windsor, Ont., Canada.
Can J Rural Med. 2011 Spring;16(2):47-54.
We examined the differential effects of the supply of physicians on care for breast cancer in Ontario and California. We then used criteria for optimum care for breast cancer to estimate the regional needs for the supply of physicians.
Ontario and California registries provided 951 and 984 instances of breast cancer diagnosed between 1998 and 2000 and followed until 2006. These cohorts were joined with the supply of county-level primary care physicians (PCPs) and specialists in cancer care and compared on care for breast cancer.
Significant protective PCP thresholds (7.75 to = 8.25 PCPs per 10 000 inhabitants) were observed for breast cancer diagnosis (odds ratio [OR] 1.62), receipt of adjuvant radiotherapy (OR 1.64) and 5-year survival (OR 1.87) in Ontario, but not in California. The number of physicians seemed adequate to optimize care for breast cancer across diverse places in California and in most Ontario locations. However, there was an estimated need for 550 more PCPs and 200 more obstetrician-gynecologists in Ontario's rural and small urban areas. We estimated gross physician surpluses for Ontario's 2 largest cities.
Policies are needed to functionally redistribute primary care and specialist physicians. Merely increasing the supply of physicians is unlikely to positively affect the health of Ontarians.
我们研究了安大略省和加利福尼亚州医生供应情况对乳腺癌护理的不同影响。然后，我们使用乳腺癌最佳护理标准来估计该地区对医生供应的需求。
安大略省和加利福尼亚州的登记处提供了1998年至2000年期间诊断出的951例和984例乳腺癌病例，并随访至2006年。这些队列与县级初级保健医生（PCP）和癌症护理专家的供应情况相结合，并就乳腺癌护理进行了比较。
在安大略省，观察到乳腺癌诊断（优势比[OR]1.62）、辅助放疗的接受情况（OR 1.64）和5年生存率（OR 1.87）存在显著的保护性PCP阈值（每10000名居民中有7.75至=8.25名PCP），但在加利福尼亚州则没有。在加利福尼亚州的不同地区以及安大略省的大多数地区，医生数量似乎足以优化乳腺癌护理。然而，估计安大略省的农村和小城市地区还需要550多名PCP和200多名妇产科医生。我们估计了安大略省两个最大城市的医生总过剩情况。
需要制定政策，在功能上重新分配初级保健医生和专科医生。仅仅增加医生供应不太可能对安大略省居民的健康产生积极影响。
