Freedland Alexis R, Muller Roberto L, Hoyo Cathrine, Turner Elizabeth L, Moorman Patricia G, Faria Eliney F, Carvalhal Gustavo F, Reis Rodolfo B, Mauad Edmundo C, Carvalho Andre L, Freedland Stephen J
Department of Epidemiology, UCI School of Medicine, University of California, Irvine, CA, USA.
Division of Urology, Center of Oncologic Research, Florianopolis, Santa Catarina, Brazil.
Prostate Cancer. 2021 Jun 22;2021:6614838. doi: 10.1155/2021/6614838. eCollection 2021.
Given growing specialization in medical care, optimal care may require regionalization, which may create access barriers. We tested this within a large prostate cancer (PC) screening program in Brazil. In 2004-2007, Barretos Cancer Hospital prospectively screened men for PC throughout rural Brazil. Men with abnormal screen were referred for follow-up and possible biopsy. We tested the link between distance from screening site to Barretos Cancer Hospital and risk of noncompliance with showing up for biopsy, PC on biopsy and, among those with PC, PC grade using crude and multivariable logistic regression analysis. Among 10,467 men undergoing initial screen, median distance was 257 km (IQR: 135-718 km). On crude and multivariable analyses, farther distance was significantly linked with biopsy noncompliance (OR/100 km: 0.83, < 0.001). Among men who lived within 150 km of Barretos Cancer Hospital, distance was unrelated to compliance (OR/100 km: 1.09, =0.87). There was no association between distance and PC risk or PC grade (all > 0.25). In Brazil, where distances to referral centers can be large, greater distance was related to reduced biopsy compliance in a PC screening cohort. Among men who lived within 150 km, distance was unrelated to compliance. Care regionalization may reduce access when distances are large.
鉴于医疗护理专业化程度不断提高，最佳护理可能需要区域化，但这可能会造成就医障碍。我们在巴西一项大型前列腺癌（PC）筛查项目中对此进行了测试。2004年至2007年期间，巴雷托斯癌症医院对巴西农村地区的男性进行了PC前瞻性筛查。筛查结果异常的男性被转诊进行后续检查及可能的活检。我们使用粗逻辑回归分析和多变量逻辑回归分析，测试了从筛查地点到巴雷托斯癌症医院的距离与活检未依从风险、活检时的PC以及患有PC的患者的PC分级之间的联系。在10467名接受初次筛查的男性中，中位距离为257公里（四分位间距：135 - 718公里）。在粗分析和多变量分析中，距离越远与活检不依从显著相关（每100公里的比值比：0.83，<0.001）。在居住在距离巴雷托斯癌症医院150公里以内的男性中，距离与依从性无关（每100公里的比值比：1.09，=0.87）。距离与PC风险或PC分级之间没有关联（所有P值>0.25）。在巴西，到转诊中心的距离可能很远，在PC筛查队列中，距离越远与活检依从性降低有关。在居住在150公里以内的男性中，距离与依从性无关。当距离较远时，护理区域化可能会减少就医机会。
