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How the probability of presentation to a primary care clinician correlates with cancer survival rates : a European survey using vignettes

Harris, Michael P; Frey, Peter; Esteva, Magdalena; Gašparović Babić, Svjetlana; Marzo-Castillejo, Mercè; Petek, Davorina; Petek Ster, Marija and Thulesius, Hans LU (2017) In Scandinavian Journal of Primary Health Care 35(1). p.27-34
Abstract

Objective: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting: A total of... (More)

Objective: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting: A total of 14 countries. Subjects: Consensus groups of PCPs. Main outcome measures: Probability of initial presentation to a PCP for four clinical vignettes. Results: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r  = −0.16, 95% CI −0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI −0.83 to −0.12; ovary: r = −0.13, 95% CI −0.57 to 0.38; breast r = 0.14, 95% CI −0.36 to 0.58; bowel: r = 0.20, 95% CI −0.31 to 0.62). Conclusions: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival.KEY POINTSEuropean cancer survival rates vary widely, and health system factors may account for some of these differences.The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP.The degree to which PCPs act as gatekeepers varies considerably from country to country.There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cancer, decision making, diagnosis, Europe, Health care systems, primary health care
in
Scandinavian Journal of Primary Health Care
volume
35
issue
1
pages
8 pages
publisher
Taylor & Francis
external identifiers
  • scopus:85014571071
  • wos:000396039600005
ISSN
0281-3432
DOI
10.1080/02813432.2017.1288692
language
English
LU publication?
yes
id
9ca0f58b-a705-4abf-b7e1-ae27e66a1005
date added to LUP
2017-03-17 14:38:39
date last changed
2018-01-07 11:56:18
@article{9ca0f58b-a705-4abf-b7e1-ae27e66a1005,
  abstract     = {<p>Objective: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting: A total of 14 countries. Subjects: Consensus groups of PCPs. Main outcome measures: Probability of initial presentation to a PCP for four clinical vignettes. Results: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r  = −0.16, 95% CI −0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI −0.83 to −0.12; ovary: r = −0.13, 95% CI −0.57 to 0.38; breast r = 0.14, 95% CI −0.36 to 0.58; bowel: r = 0.20, 95% CI −0.31 to 0.62). Conclusions: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival.KEY POINTSEuropean cancer survival rates vary widely, and health system factors may account for some of these differences.The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP.The degree to which PCPs act as gatekeepers varies considerably from country to country.There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.</p>},
  author       = {Harris, Michael P and Frey, Peter and Esteva, Magdalena and Gašparović Babić, Svjetlana and Marzo-Castillejo, Mercè and Petek, Davorina and Petek Ster, Marija and Thulesius, Hans},
  issn         = {0281-3432},
  keyword      = {cancer,decision making,diagnosis,Europe,Health care systems,primary health care},
  language     = {eng},
  month        = {03},
  number       = {1},
  pages        = {27--34},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Primary Health Care},
  title        = {How the probability of presentation to a primary care clinician correlates with cancer survival rates : a European survey using vignettes},
  url          = {http://dx.doi.org/10.1080/02813432.2017.1288692},
  volume       = {35},
  year         = {2017},
}