Département Universitaire de Médecine Générale, Université Toulouse 3 Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.
Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France.
BMC Prim Care. 2023 Aug 29;24(1):167. doi: 10.1186/s12875-023-02122-5.
The aims of the "médecin traitant" or referring physician (RP) reform, introduced in France in 2004, were to improve the organisation and quality of care and to allow for greater equity, particularly in terms of prevention. The objective of our study was to evaluate the effect of having a declared RP on the uptake of screening for breast and cervical cancers, and to explore the mechanisms involved.
We used an existing dataset of 1,072,289 women, which combines data from the Health Insurance information systems, with census data. We built multivariable logistic regression models to study the effect of having a RP on the uptake of mammography and pap smear, adjusted for age, socio-economic level, health status and healthcare provision. We secondarily added to this model the variable "having consulted a General Practitioner (GP) within the year". Finally, we evaluated the interaction between the effect of having a referring physician and the area of residence (metropolitan/urban/rural).
Patients who had a declared RP had a significantly higher uptake of mammography and pap smear than those who did not. The strength of the association was particularly important in very urban areas. The effect of having visited a GP seemed to explain a part of the correlation between having a RP and uptake of screening.
Lower rates of gynaecological screening among women without an RP compared to those with an RP may partly reflect a specific behaviour pattern in women less adherent to the health care system. However, this result also shows the importance of the RP, who assumes the key role of relaying public health information in a more personalised and adapted way.
“主治医生”或转诊医生（RP）改革于 2004 年在法国推出，旨在改善医疗服务的组织和质量，并提高公平性，尤其是在预防方面。我们的研究目的是评估有明确的 RP 对乳腺癌和宫颈癌筛查的参与率的影响，并探讨相关机制。
我们使用了一个现有的 1072289 名女性的数据集，该数据集结合了健康保险信息系统和人口普查数据。我们构建了多变量逻辑回归模型，以研究有 RP 对乳房 X 光检查和巴氏涂片检查的参与率的影响，调整了年龄、社会经济水平、健康状况和医疗服务提供情况。我们还在该模型中加入了“一年内是否咨询过全科医生”这一变量。最后，我们评估了 RP 的效果与居住地区（城市/城区/农村）之间的相互作用。
有明确 RP 的患者接受乳房 X 光检查和巴氏涂片检查的比例明显高于没有 RP 的患者。这种关联的强度在非常城市化的地区尤为显著。看全科医生的效果似乎解释了 RP 和筛查参与率之间相关性的一部分。
与有 RP 的患者相比，没有 RP 的患者妇科筛查率较低，这可能部分反映了那些对医疗保健系统依从性较低的女性的特定行为模式。然而，这一结果也显示了 RP 的重要性，RP 承担着以更个性化和适应的方式传递公共卫生信息的关键角色。
