Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen.
NIVEL Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
Br J Gen Pract. 2022 Jul 28;72(721):e592-e600. doi: 10.3399/BJGP.2021.0519. Print 2022 Aug.
Follow-up for cancer typically occurs in secondary care, and improved survival has increased demands on these services. Other care models may alleviate this burden, such as moving (parts of) follow-up care for curatively treated patients from secondary to primary care (care substitution).
To explore the opinions of GPs regarding the potential benefits, barriers, and requirements of care substitution for breast and colorectal cancer.
A qualitative study of the opinions of purposively sampled GPs in Dutch primary care.
Focus group sessions and individual semi-structured interviews were recorded and transcribed verbatim. Data were analysed by two independent researchers using thematic analysis.
Two focus groups ( = 14) were conducted followed by nine individual interviews. Three main themes were identified: perceived benefits, perceived barriers, and perceived requirements. Perceived benefits included better accessibility and continuity of care, and care closer to patients' homes. Uncertainty about cancer-related competences and practical objections were perceived as barriers. Requirements included close specialist collaboration, support from patients for this change, and stepwise implementation to avoid loss of existing care quality.
Most GPs reported that they were not in favour of complete care substitution, but that primary care could have greater formal involvement in oncological follow-up if there is close collaboration with secondary care (that is, shared care), support from patients, sufficient resource allocation, stepwise implementation with clear guidelines, and monitoring of quality. Clear and broadly supported protocols need to be developed and tested before implementing follow-up in primary care.
癌症的随访通常发生在二级医疗保健机构，而生存的改善增加了对这些服务的需求。其他护理模式可能会减轻这种负担，例如将接受根治性治疗的患者的（部分）随访护理从二级医疗保健转移到初级医疗保健（护理替代）。
探讨全科医生对将乳腺癌和结直肠癌的随访护理从二级医疗保健转移到初级医疗保健（护理替代）的潜在益处、障碍和要求的看法。
这是一项在荷兰初级保健中对有目的地抽样的全科医生意见的定性研究。
记录了焦点小组会议和个别半结构化访谈，并逐字转录。两名独立研究人员使用主题分析对数据进行分析。
进行了两次焦点小组讨论（每组 14 人），随后进行了九次个别访谈。确定了三个主要主题：感知到的益处、感知到的障碍和感知到的要求。感知到的益处包括更好的可及性和连续性护理，以及更接近患者家庭的护理。对癌症相关能力的不确定性和实际反对意见被视为障碍。要求包括与专科医生的密切合作、患者对这一变化的支持，以及分阶段实施以避免现有护理质量的丧失。
大多数全科医生表示，他们不赞成完全的护理替代，但如果与二级医疗保健（即共享护理）密切合作、得到患者的支持、充分分配资源、分阶段实施并明确指导方针以及监测质量，初级医疗保健可以更多地正式参与肿瘤学随访。在实施初级保健中的随访之前，需要制定和测试明确和广泛支持的方案。
