国际成人癌症幸存者卫生服务利用模式和决定因素综述。
An international review of the patterns and determinants of health service utilisation by adult cancer survivors.
机构信息
Cancer Epidemiology & Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK.
出版信息
BMC Health Serv Res. 2012 Sep 13;12:316. doi: 10.1186/1472-6963-12-316.
BACKGROUND
There is a need to review factors related to health service utilisation by the increasing number of cancer survivors in order to inform care planning and the organisation and delivery of services.
METHODS
Studies were identified via systematic searches of Medline, PsycINFO, CINAHL, Social Science Citation Index and the SEER-MEDICARE library. Methodological quality was assessed using STROBE; and the Andersen Behavioural Model was used as a framework to structure, organise and analyse the results of the review.
RESULTS
Younger, white cancer survivors were most likely to receive follow-up screening, preventive care, visit their physician, utilise professional mental health services and least likely to be hospitalised. Utilisation rates of other health professionals such as physiotherapists were low. Only studies of health service use conducted in the USA investigated the role of type of health insurance and ethnicity. There appeared to be disparate service use among US samples in terms of ethnicity and socio-demographic status, regardless of type of health insurance provision s- this may be explained by underlying differences in health-seeking behaviours. Overall, use of follow-up care appeared to be lower than expected and barriers existed for particular groups of cancer survivors.
CONCLUSIONS
Studies focussed on the use of a specific type of service rather than adopting a whole-system approach and future health services research should address this shortcoming. Overall, there is a need to improve access to care for all cancer survivors. Studies were predominantly US-based focussing mainly on breast or colorectal cancer. Thus, the generalisability of findings to other health-care systems and cancer sites is unclear. The Andersen Behavioural Model provided an appropriate framework for studying and understanding health service use among cancer survivors. The active involvement of physicians and use of personalised care plans are required in order to ensure that post-treatment needs and recommendations for care are met.
背景
需要审查与不断增加的癌症幸存者相关的健康服务利用因素，以便为护理计划以及服务的组织和提供提供信息。
方法
通过系统检索 Medline、PsycINFO、CINAHL、社会科学引文索引和 SEER-MEDICARE 库，确定了研究。使用 STROBE 评估方法学质量；并使用 Andersen 行为模型作为框架，对综述的结果进行结构、组织和分析。
结果
年轻、白人癌症幸存者最有可能接受后续筛查、预防保健、看医生、利用专业心理健康服务，而最不可能住院。其他健康专业人员（如物理治疗师）的利用率较低。只有在美国进行的健康服务使用研究调查了健康保险类型和种族的作用。无论提供哪种类型的健康保险，美国样本的种族和社会人口统计学地位似乎存在差异的服务使用情况-这可能是由于健康寻求行为的潜在差异所致。总体而言，后续护理的使用似乎低于预期，并且特定群体的癌症幸存者存在障碍。
结论
研究侧重于使用特定类型的服务，而不是采用整体系统方法，未来的卫生服务研究应该解决这一不足。总体而言，需要改善所有癌症幸存者的护理机会。研究主要集中在美国，主要关注乳腺癌或结直肠癌。因此，研究结果对其他医疗保健系统和癌症部位的推广性尚不清楚。Andersen 行为模型为研究和理解癌症幸存者的健康服务利用提供了一个合适的框架。需要医生的积极参与和使用个性化护理计划，以确保满足治疗后的需求和护理建议。
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