癌症存活率方面的严重问题是否部分源于守门人原则？一项生态学研究。
Are the serious problems in cancer survival partly rooted in gatekeeper principles? An ecologic study.
机构信息
The Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
出版信息
Br J Gen Pract. 2011 Aug;61(589):e508-12. doi: 10.3399/bjgp11X588484.
Abstract
BACKGROUND
It is puzzling to note that British and Danish citizens have a poorer cancer prognosis than citizens from other countries, and this study hypothesises that their low cancer survival could be partly rooted in the gatekeeper function undertaken by general practice in these two countries.
AIM
To test the association between principles of gatekeeper systems and cancer survival.
DESIGN AND SETTING
An ecologic study with data from EUROCARE-4 and primary care structure.
METHOD
This hypothesis was tested in an ecologic study on the association between three principles of gatekeeper systems and cancer survival in 19 European countries for which valid and full data were available.
RESULTS
It was found that healthcare systems with a gatekeeper system do have a significantly lower 1-year relative cancer survival than systems without such gatekeeper functions.
CONCLUSION
The possible mechanisms behind this finding are discussed, and while all the positive aspects of gatekeeping are recognised, it is strongly recommended that further research be conducted to confirm or reject the study hypothesis on this possible serious adverse effect of gatekeeping.
摘要
背景
令人费解的是，英国和丹麦公民的癌症预后比其他国家的公民差，本研究假设他们较低的癌症生存率可能部分源于这两个国家的初级保健在守门人功能方面的欠缺。
目的
检验守门人制度原则与癌症生存率之间的关联。
设计和设置
采用 EUROCARE-4 和初级保健结构数据的生态学研究。
方法
在这项关于欧洲 19 个国家的守门人制度的三个原则与癌症生存率之间的关联的生态学研究中，检验了这一假设，这些国家有有效的和完整的数据。
结果
发现具有守门人制度的医疗保健系统的 1 年相对癌症生存率明显低于没有这种守门人功能的系统。
结论
对这一发现背后的可能机制进行了讨论，虽然认识到守门的所有积极方面，但强烈建议进行进一步的研究，以确认或否定这一可能对守门产生严重不利影响的研究假设。
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