Heins Marianne, Schellevis François, Schotman Mirjam, van Bezooijen Bart, Tchaoussoglou Ismene, van der Waart Mirjam, Veldhuis Lilan, van Dulmen Sandra, Donker Gé, Korevaar Joke
Researcher, Department of General Practice, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
Professor, Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands.
BJGP Open. 2018 Dec 12;2(4):bjgpopen18X101616. doi: 10.3399/bjgpopen18X101616. eCollection 2018 Dec.
The number of patients with prostate cancer is increasing, which puts additional pressure on health care. GP-led follow up may help reduce costs, travel time for patients, and workload for urologists and improve continuity of care.
To test the feasibility and acceptability of a new clinical pathway for GP-led prostate cancer follow-up.
DESIGN & SETTING: A feasibility pilot study was performed in cooperation with six GP practices in the Dutch region of Amersfoort.
The study included 20 patients with prostate cancer in a stable phase, who were aged ≥65 years and with comorbidity. Follow-up for prostate cancer was transferred to the GP for one year. Participating GPs and urologists jointly developed a protocol. Patient satisfaction was measured at 0 and 12 months with the 'personalised care' subscale of the Consumer Quality (CQ) index 'general practice care'. Next, patients, GPs, and urologists were interviewed about their experiences. The clinical pathway was considered successful if no patients were referred back to the urologist, except for an increase in prostate-specific antigen (PSA), and if the majority of patients and participating urologists and GPs were satisfied.
Of the 20 patients included in the study, three were referred back to the urologist because of increasing PSA levels and one died (unrelated to prostate cancer). Most patients (73%) were satisfied with the transfer of care, indicated by a score of ≥3 on the 'personalised care' subscale. GPs and urologists had confidence in the ability of GPs to provide follow-up care and preferred to continue this.
The new clinical pathway was successful, warranting a larger study to provide evidence for the (cost-)effectiveness of GP-led prostate cancer follow-up.
前列腺癌患者数量不断增加，这给医疗保健带来了额外压力。由全科医生主导的随访可能有助于降低成本、减少患者的出行时间以及减轻泌尿科医生的工作量，并改善护理的连续性。
测试一种由全科医生主导的前列腺癌随访新临床路径的可行性和可接受性。
在荷兰阿默斯福特地区与六个全科医生诊所合作进行了一项可行性试点研究。
该研究纳入了20例处于稳定期的前列腺癌患者，年龄≥65岁且患有合并症。前列腺癌的随访工作转由全科医生负责一年。参与的全科医生和泌尿科医生共同制定了一项方案。在0个月和12个月时，使用消费者质量（CQ）指数“全科医疗服务”中的“个性化护理”子量表来衡量患者满意度。接下来，对患者、全科医生和泌尿科医生进行了关于他们经历的访谈。如果除前列腺特异性抗原（PSA）升高外没有患者被转回泌尿科医生处，并且大多数患者以及参与的泌尿科医生和全科医生感到满意，则认为该临床路径是成功的。
在纳入研究的20例患者中，3例因PSA水平升高被转回泌尿科医生处，1例死亡（与前列腺癌无关）。大多数患者（73%）对护理的转移感到满意，“个性化护理”子量表得分≥3表明了这一点。全科医生和泌尿科医生对全科医生提供随访护理的能力有信心，并倾向于继续这样做。
新的临床路径是成功的，有必要进行更大规模的研究，为全科医生主导的前列腺癌随访的（成本）效益提供证据。
