Département Universitaire de Médecine Générale, Université de Toulouse, Faculté de Médecine, Toulouse, 31062, France.
Equity Team: Team Labeled By the French League Against Cancer, UMR1295 CERPOP, Toulouse, 31073, France.
BMC Public Health. 2024 Oct 9;24(1):2748. doi: 10.1186/s12889-024-18942-8.
Vulnerable social groups have greater difficulty in accessing care and a lower quality of care. Health systems focused on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care are persisting. We focused on primary care screening for cervical cancer through Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing disease incidence and mortality. In this study, we aimed to investigate the characteristics of women who undergo CUS according to the category of health professionals (general practitioners or gynaecologists) performing CUS and to analyse potential differences in access to care in terms of socioeconomic and geographical characteristics.
This was a retrospective observational study based on data from the main health insurance schemes in France, allowing analysis of health care consumption according to socioeconomic levels and proximity to health care services. We included women aged 25 to 64 years in 2012 for whom CUS would be a relevant procedure (695,694). The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed using multinomial logistic regression.
A total of 202,271 (29%) patients underwent CUS; of whom 68% underwent CUS administered by gynaecologists and 28% were administered by general practitioners (GPs). However, inequalities in CUS screening rates were observed, with a decrease in the number of CUSs performed with increased age, a rural location, deprivation, and sparse health care provisions. Deprived people seemed less penalised by GPs.
Involvement of General Practitioners may improve cervical screening equality in France. The organisation of health systems around primary care may allow a better access to care and to account for the specific needs of deprived populations.
弱势群体在获得医疗保健方面面临更大的困难，并且其获得的医疗保健质量也较低。以初级保健为重点的卫生系统似乎更有效、更高效和更公平。然而，获得初级保健的困难仍然存在。我们专注于通过子宫颈涂片（CUS）进行的宫颈癌初级保健筛查，该方法已被证明可以有效降低疾病发病率和死亡率。在这项研究中，我们旨在根据执行 CUS 的卫生专业人员（全科医生或妇科医生）类别，研究接受 CUS 的妇女的特征，并分析在社会经济和地理特征方面获得医疗保健的潜在差异。
这是一项基于法国主要健康保险计划数据的回顾性观察性研究，允许根据社会经济水平和接近医疗服务的程度分析医疗保健消费。我们纳入了 2012 年年龄在 25 至 64 岁之间、需要进行 CUS 的女性（695694 人）。社会人口统计学和地域指标包括年龄、地域剥夺程度和妇科保健的可用性。分析采用多项逻辑回归。
共有 202271 名（29%）患者接受了 CUS；其中 68%由妇科医生进行了 CUS，28%由全科医生（GP）进行了 CUS。然而，CUS 筛查率存在不平等现象，随着年龄的增长、农村地区、贫困和医疗服务匮乏，CUS 的数量减少。贫困人群似乎较少受到全科医生的影响。
全科医生的参与可能会提高法国宫颈癌筛查的公平性。以初级保健为中心的卫生系统组织可以更好地获得医疗保健，并考虑到贫困人群的特殊需求。
