Pollack Craig Evan, Ross Michelle E, Armstrong Katrina, Branas Charles C, Rhodes Karin V, Bekelman Justin E, Wentz Alicia, Stillson Christian, Radhakrishnan Archana, Oyeniran Enny, Grande David
Department of Medicine, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2016 Oct 10;11(10):e0164411. doi: 10.1371/journal.pone.0164411. eCollection 2016.
Prior work suggests that access to health care may influence the diagnosis and treatment of prostate cancer. Mystery-caller methods have been used previously to measure access to care for health services such as primary care, where patients' self-initiate requests for care. We used a mystery-caller survey for specialized prostate cancer care to assess dimensions of access to prostate cancer care.
We created an inventory of urology and radiation oncology practices in southeastern Pennsylvania. Using a 'mystery caller' approach, a research assistant posing as a medical office scheduler in a primary care office, attempted to make a new patient appointment on behalf of a referred patient. Linear regression was used to determine the association between time to next available appointment with practice and census tract characteristics.
We successfully obtained information on new patient appointments from 198 practices out of the 223 in the region (88.8%). Radiation oncology practices were more likely to accept Medicaid compared to urology practices (91.3% vs 36.4%) and had shorter mean wait times for new patient appointments (9.0 vs 12.8 days). We did not observe significant differences in wait times according to census tract characteristics including neighborhood socioeconomic status and the proportion of male African American residents.
Mystery-caller methods that reflect real-world referral processes from primary care offices can be used to measure access to specialized cancer care. We observed significant differences in wait times and insurance acceptance between radiation oncology and urology practices.
先前的研究表明，获得医疗保健服务可能会影响前列腺癌的诊断和治疗。神秘呼叫者方法此前已被用于衡量诸如初级保健等医疗服务的可及性，在初级保健中患者会主动寻求医疗服务。我们使用神秘呼叫者调查来评估前列腺癌专科护理的可及性维度。
我们编制了宾夕法尼亚州东南部泌尿外科和放射肿瘤学医疗机构的清单。采用“神秘呼叫者”方法，一名研究助理假扮成初级保健办公室的医疗预约调度员，试图代表一名转诊患者预约新患者就诊。使用线性回归来确定下一次可预约就诊时间与医疗机构及普查区特征之间的关联。
我们成功从该地区223家医疗机构中的198家（88.8%）获取了新患者预约的信息。与泌尿外科相比，放射肿瘤学医疗机构更有可能接受医疗补助（91.3%对36.4%），且新患者预约的平均等待时间更短（9.0天对12.8天）。根据普查区特征，包括邻里社会经济地位和男性非裔美国居民比例，我们未观察到等待时间存在显著差异。
反映初级保健办公室实际转诊流程的神秘呼叫者方法可用于衡量获得专科癌症护理的可及性。我们观察到放射肿瘤学和泌尿外科在等待时间和保险接受方面存在显著差异。
