Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Fam Pract. 2019 May 23;36(3):255-261. doi: 10.1093/fampra/cmy069.
One-stop clinics provide comprehensive diagnostic testing in one outpatient appointment. They could benefit patients with conditions, such as cancer, whose outcomes are improved by early diagnosis, and bring efficiency savings for health systems.
To assess the use and outcomes of one-stop clinics for symptoms where cancer is a possible diagnosis.
Systematic review of studies reporting use and outcomes of one-stop clinics in primary care patients.
We searched MEDLINE, Embase, and Cochrane Library for studies assessing one-stop clinics for adults referred after presenting to primary care with any symptom that could be indicative of cancer. Study selection was carried out independently in duplicate with disagreements resolved through discussion.
Twenty-nine studies were identified, most were conducted in the UK and observational in design. Few included a comparison arm. A pooled comparison of the cancer conversion rate of one-stop and multi-stop clinics was only possible for breast symptoms, and we found no significant difference. One-stop clinics were associated with significant reductions in the interval from referral to testing (15 versus 75 days) and more patients diagnosed on the same day (79% versus 25%) compared to multi-stop pathways. The majority of patients and GPs found one-stop clinics to be acceptable.
This review found one-stop clinics were associated with reduced time from referral to testing, increased same day diagnoses, and were acceptable to patients and GPs. Our conclusions are limited by high levels of heterogeneity, scarcity of comparator groups, and the overwhelmingly observational nature of included studies.
一站式诊所可在一次门诊预约中提供全面的诊断检测。对于癌症等疾病的患者，早期诊断可改善其预后，同时也可提高卫生系统的效率。
评估在疑似癌症症状患者中使用和实施一站式诊所的情况及其效果。
对报告初级保健患者中使用和实施一站式诊所的研究进行系统评价。
我们在 MEDLINE、Embase 和 Cochrane Library 中检索了评估成年人因任何可能提示癌症的症状就诊初级保健后转至一站式诊所的研究。研究选择由两人独立进行，如有分歧则通过讨论解决。
共确定了 29 项研究，其中大多数研究在英国进行，且为观察性设计。很少有研究包括对照组。仅对乳房症状的一站式和多站式诊所的癌症转化率进行了汇总比较，我们未发现其存在显著差异。与多站式途径相比，一站式诊所可显著缩短从转介到检测的时间（15 天比 75 天），且更多患者可在同一天得到诊断（79%比 25%）。与多站式途径相比，大多数患者和全科医生认为一站式诊所可接受。
本综述发现，与多站式途径相比，一站式诊所可缩短从转介到检测的时间，增加当天的诊断，并可被患者和全科医生接受。我们的结论受到高度异质性、缺乏对照组以及纳入研究绝大多数为观察性研究的限制。
