Ridd Matthew J, Ferreira Diana L Santos, Montgomery Alan A, Salisbury Chris, Hamilton William
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
Nottingham Clinical Trials Unit, University of Nottingham, Nottingham.
Br J Gen Pract. 2015 May;65(634):e305-11. doi: 10.3399/bjgp15X684829.
Continuity of care may affect the diagnostic process in cancer but there is little research.
To estimate associations between patient-doctor continuity and time to diagnosis and referral of three common cancers.
Retrospective cohort study in general practices in England.
This study used data from the General Practice Research Database for patients aged ≥40 years with a diagnosis of breast, colorectal, or lung cancer. Relevant cancer symptoms or signs were identified up to 12 months before diagnosis. Patient-doctor continuity (fraction-of-care index adjusted for number of consultations) was calculated up to 24 months before diagnosis. Time ratios (TRs) were estimated using accelerated failure time regression models.
Patient-doctor continuity in the 24 months before diagnosis was associated with a slightly later diagnosis of colorectal (time ratio [TR] 1.01, 95% confidence interval [CI] =1.01 to 1.02) but not breast (TR = 1.00, 0.99 to 1.01) or lung cancer (TR = 1.00, 0.99 to 1.00). Secondary analyses suggested that for colorectal and lung cancer, continuity of doctor before the index consultation was associated with a later diagnosis but continuity after the index consultation was associated with an earlier diagnosis, with no such effects for breast cancer. For all three cancers, most of the delay to diagnosis occurred after referral.
Any effect for patient-doctor continuity appears to be small. Future studies should compare investigations, referrals, and diagnoses in patients with and without cancer who present with possible cancer symptoms or signs; and focus on 'difficult to diagnose' types of cancer.
医疗连续性可能会影响癌症的诊断过程，但相关研究较少。
评估患者与医生之间的连续性与三种常见癌症的诊断时间和转诊时间之间的关联。
在英格兰的全科医疗中进行的回顾性队列研究。
本研究使用了全科医疗研究数据库中年龄≥40岁、被诊断患有乳腺癌、结直肠癌或肺癌的患者数据。在诊断前12个月内识别出相关癌症症状或体征。计算诊断前24个月内的患者-医生连续性（根据咨询次数调整的照护比例指数）。使用加速失效时间回归模型估计时间比（TRs）。
诊断前24个月内的患者-医生连续性与结直肠癌诊断稍晚相关（时间比[TR]为1.01，95%置信区间[CI]=1.01至1.02），但与乳腺癌（TR=1.00，0.99至1.01）或肺癌（TR=1.00，0.99至1.00）无关。二次分析表明，对于结直肠癌和肺癌，索引咨询前医生的连续性与诊断延迟相关，但索引咨询后连续性与诊断提前相关，乳腺癌则无此影响。对于所有三种癌症，大部分诊断延迟发生在转诊之后。
患者-医生连续性的任何影响似乎都很小。未来的研究应比较出现可能癌症症状或体征的癌症患者和非癌症患者的检查、转诊和诊断情况；并关注“难以诊断”的癌症类型。
