Kepka Deanna, Smith Alexandria, Zeruto Christopher, Yabroff K Robin
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
BMC Cancer. 2014 Mar 31;14:233. doi: 10.1186/1471-2407-14-233.
Physician recommendations for cancer screening and prevention are associated with patient compliance. However, time constraints may limit physicians' ability to provide all recommended preventive services, especially with increasing demand from the Affordable Care Act in the United States. Team-based practice that includes advanced practice registered nurses and physician assistants (APRN/PA) may help meet this demand. This study investigates the relationship between an APRN/PA visit and receipt of guideline-consistent cancer screening and prevention recommendations.
Data from the 2010 National Health Interview Survey were analyzed with multivariate logistic regression to assess provider type seen and receipt of guideline-consistent cancer screening and prevention recommendations (n = 26,716).
In adjusted analyses, women who saw a primary care physician (PCP) and an APRN/PA or a PCP without an APRN/PA in the past 12 months were more likely to be compliant with cervical and breast cancer screening guidelines than women who did not see a PCP or APRN/PA (all p < 0.0001 for provider type). Women and men who saw a PCP and an APRN/PA or a PCP without an APRN/PA were also more likely to receive guideline consistent colorectal cancer screening and advice to quit smoking and participate in physical activity than women and men who did not see a PCP or APRN/PA (all p < 0.01 for provider type).
Seeing a PCP alone, or in conjunction with an APRN/PA is associated with patient receipt of guideline-consistent cancer prevention and screening recommendations. Integrating APRN/PA into primary care may assist with the delivery of cancer prevention and screening services. More intervention research efforts are needed to explore how APRN/PA will be best able to increase cancer screening, HPV vaccination, and receipt of behavioral counseling, especially during this era of healthcare reform.
医生关于癌症筛查和预防的建议与患者的依从性相关。然而,时间限制可能会限制医生提供所有推荐的预防服务的能力,尤其是在美国《平价医疗法案》带来的需求不断增加的情况下。包括高级执业注册护士和医师助理(APRN/PA)在内的团队协作医疗模式可能有助于满足这一需求。本研究调查了APRN/PA诊疗与符合指南的癌症筛查和预防建议的接受情况之间的关系。
对2010年全国健康访谈调查的数据进行多变量逻辑回归分析,以评估所就诊的医疗服务提供者类型以及符合指南的癌症筛查和预防建议的接受情况(n = 26,716)。
在调整分析中,在过去12个月内看过初级保健医生(PCP)以及APRN/PA或只看过PCP而未看过APRN/PA的女性,比未看过PCP或APRN/PA的女性更有可能遵守宫颈癌和乳腺癌筛查指南(所有医疗服务提供者类型的p值均<0.0001)。看过PCP以及APRN/PA或只看过PCP而未看过APRN/PA的男性和女性,也比未看过PCP或APRN/PA的男性和女性更有可能接受符合指南的结直肠癌筛查,并获得戒烟和参加体育活动的建议(所有医疗服务提供者类型的p值均<0.01)。
单独看PCP或与APRN/PA一起就诊与患者接受符合指南的癌症预防和筛查建议相关。将APRN/PA纳入初级保健可能有助于提供癌症预防和筛查服务。需要更多的干预性研究来探索APRN/PA如何能够最好地提高癌症筛查、人乳头瘤病毒(HPV)疫苗接种率以及行为咨询的接受度,尤其是在当前医疗改革时代。