Harris Michael, Vedsted Peter, Esteva Magdalena, Murchie Peter, Aubin-Auger Isabelle, Azuri Joseph, Brekke Mette, Buczkowski Krzysztof, Buono Nicola, Costiug Emiliana, Dinant Geert-Jan, Foreva Gergana, Gašparović Babić Svjetlana, Hoffman Robert, Jakob Eva, Koskela Tuomas H, Marzo-Castillejo Mercè, Neves Ana Luísa, Petek Davorina, Petek Ster Marija, Sawicka-Powierza Jolanta, Schneider Antonius, Smyrnakis Emmanouil, Streit Sven, Thulesius Hans, Weltermann Birgitta, Taylor Gordon
Department for Health, University of Bath, Bath, UK.
Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland.
BMJ Open. 2018 Sep 5;8(9):e022904. doi: 10.1136/bmjopen-2018-022904.
Cancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners' (PCPs') referral decisions is lacking.This study analyses health system factors potentially influencing PCPs' referral decision-making when consulting with patients who may have cancer, and how these vary between European countries.
Based on a content-validity consensus, a list of 45 items relating to a PCP's decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs' referral decision-making.
A primary care study; 25 participating centres in 20 European countries.
1830 PCPs completed the survey. The median response rate for participating centres was 20.7%.
The factors derived from items related to PCPs' referral decision-making. Mean factor scores were produced for each country, allowing comparisons.
Factor analysis identified five underlying factors: PCPs' ability to refer; degree of direct patient access to secondary care; PCPs' perceptions of being under pressure; expectations of PCPs' role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses.
Five healthcare system factors influencing PCPs' referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.
欧洲各地癌症生存率以及诊断和治疗时的疾病阶段差异很大。这些差异可能部分归因于检查和专科医生获取途径的不同。然而，缺乏能解释不同国家卫生系统如何影响初级保健医生（PCP）转诊决策的证据。本研究分析了在与可能患有癌症的患者会诊时，可能影响初级保健医生转诊决策的卫生系统因素，以及这些因素在欧洲国家之间的差异。
基于内容效度共识，将与初级保健医生转诊有潜在癌症症状患者进行进一步检查决策相关的45项内容清单缩减至20项。20项内容的在线问卷由初级保健医生采用五点李克特量表作答，表明每项内容对其针对可能患有癌症患者的决策影响程度。探索性因素分析确定了初级保健医生转诊决策的潜在因素。
一项初级保健研究；20个欧洲国家的25个参与中心。
1830名初级保健医生完成了调查。参与中心的中位回应率为20.7%。
从与初级保健医生转诊决策相关项目中得出的因素。计算每个国家的平均因素得分以便进行比较。
因素分析确定了五个潜在因素：初级保健医生的转诊能力；患者直接获得二级保健的程度；初级保健医生对压力的感知；对初级保健医生角色的期望；以及初级保健医生认为其卫生系统中质量优先于成本的程度。这些因素占个体反应间观察方差的47.4%。
确定了影响20个欧洲国家初级保健医生转诊决策的五个卫生保健系统因素。这些因素在欧洲国家之间差异很大。了解这些因素有助于制定卫生服务政策以改善癌症治疗结果，并为未来比较各国癌症诊断途径和结果的研究提供信息。
