Toftegaard Berit Skjødeberg, Bro Flemming, Falborg Alina Zalounina, Vedsted Peter
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, DK-8000, Denmark.
Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, DK-8000, Denmark.
BMC Fam Pract. 2017 Mar 21;18(1):44. doi: 10.1186/s12875-017-0607-3.
Detection of cancer in general practice is challenging because symptoms are diverse. Even so-called alarm symptoms have low positive predictive values of cancer. Nevertheless, appropriate referral is crucial. As 85% of cancer patients initiate their cancer diagnostic pathway in general practice, a Continuing Medical Education meeting (CME-M) in early cancer diagnosis was launched in Denmark in 2012. We aimed to investigate the effect of the CME-M on the primary care interval, patient contacts with general practice and use of urgent cancer referrals.
A before-after study was conducted in the Central Denmark Region included 396 general practices, which were assigned to one of eight geographical clusters. Practices were invited to participate in the CME-M with three-week intervals between clusters. Based on register data, we calculated urgent referral rates and patient contacts with general practice before referral. Information about primary care intervals was collected by requesting general practitioners to complete a one-page form for each urgent referral during an 8-month period around the time of the CME-Ms. CME-M practices were compared with non-participating reference practices by analysing before-after differences.
Forty percent of all practices participated in the CME-M. There was a statistically significant reduction in the number of total contacts with general practice from urgently referred patients in the month preceding the referral and an increase in the proportion of patients who waited 14 days or more in general practice from the reported date of symptom presentation to the referral date from before to after the CME-M in the CME-M group compared to the reference group.
We found a reduced number of total patient contacts with general practice within the month preceding an urgent referral and an increase in the reported primary care intervals of urgently referred patients in the CME-M group. The trend towards higher urgent referral rates and longer primary care intervals may suggest raised awareness of unspecific cancer symptoms, which could cause the GP to register an earlier date of first symptom presentation. The standardised CME-M may contribute to optimising the timing and the use of urgent cancer referral.
NCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014.
在全科医疗中检测癌症具有挑战性，因为症状多种多样。即便所谓的警示症状对癌症的阳性预测值也很低。然而，恰当的转诊至关重要。由于85%的癌症患者在全科医疗中开启其癌症诊断流程，2012年丹麦启动了一场关于早期癌症诊断的继续医学教育会议（CME-M）。我们旨在调查CME-M对初级保健间隔、患者与全科医疗的接触以及紧急癌症转诊使用情况的影响。
在丹麦中部地区开展了一项前后对照研究，纳入396家全科诊所，这些诊所被分配到八个地理群组之一。各群组之间间隔三周邀请诊所参与CME-M。基于登记数据，我们计算了紧急转诊率以及转诊前患者与全科医疗的接触情况。通过要求全科医生在CME-M前后约8个月的时间内为每例紧急转诊填写一份单页表格，收集有关初级保健间隔的信息。通过分析前后差异，将参与CME-M的诊所与未参与的对照诊所进行比较。
所有诊所中有40%参与了CME-M。与对照组相比，CME-M组在转诊前一个月内紧急转诊患者与全科医疗的总接触次数有统计学意义的减少，且从症状出现报告日期到转诊日期在全科医疗中等待14天或更长时间的患者比例从CME-M之前到之后有所增加。
我们发现CME-M组在紧急转诊前一个月内患者与全科医疗的总接触次数减少，且紧急转诊患者报告的初级保健间隔增加。紧急转诊率上升和初级保健间隔延长的趋势可能表明对非特异性癌症症状的认识提高，这可能导致全科医生记录更早症状出现日期。标准化的CME-M可能有助于优化紧急癌症转诊的时机和使用。
ClinicalTrials.gov上的NCT02069470。追溯注册，2014年1月29日。
