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Peter Vedsted

Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion: a European cross-sectional survey

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

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  • Michael Harris, Department for Health, University of Bath, Bath, UK., Storbritannien
  • Peter Vedsted
  • Magdalena Esteva, Primary Care Research Unit, Primary Care Majorca Department, Balearic Islands Health Research Institute (IdISBa), Reina Esclaramunda 9, Palma Mallorca 07003, Spain.
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  • Peter Murchie, Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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  • Isabelle Aubin-Auger, Department of General Practice, Université Paris Diderot, Paris, France.
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  • Joseph Azuri, Department of Family Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
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  • Mette Brekke, Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway.
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  • Krzysztof Buczkowski, Department of Family Medicine, Nicolaus Copernicus University, Toruń, Poland.
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  • Nicola Buono, Department of General Practice, National Society of Medical Education in General Practice (SNaMID), Caserta, Italy.
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  • Emiliana Costiug, Family Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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  • Geert-Jan Dinant, Department of General Practice, Maastricht University, Maastricht, The Netherlands.
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  • Gergana Foreva, Medical Center BROD, Plovdiv, Bulgaria.
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  • Svjetlana Gašparović Babić, Odjel Socijalne Medicine, The Teaching Institute of Public Health of Primorsko-goranska County, Rijeka, Croatia.
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  • Robert Hoffman, Department of Family Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
  • ,
  • Eva Jakob, Primary Health Centre, Centro de Saúde Sarria, Sarria, Spain.
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  • Tuomas H Koskela, Department of General Practice, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
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  • Mercè Marzo-Castillejo, Unitat de Suport a la Recerca, IDIAP Jordi Gol, Institut Catala De La Salut, Barcelona, Spain.
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  • Ana Luísa Neves, CINTESIS (Center for Health Technology and Services Research) and MEDCIDS (Department of Community Medicine, Information and Health Decision Sciences), Faculty of Medicine, University of Porto, Porto, Portugal.
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  • Davorina Petek, Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia.
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  • Marija Petek Ster, Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia.
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  • Jolanta Sawicka-Powierza, Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland.
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  • Antonius Schneider, Institute of General Practice and Health Services Research, Technische Universität München, Munich, Germany.
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  • Emmanouil Smyrnakis, Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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  • Sven Streit, Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland.
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  • Hans Thulesius, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
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  • Birgitta Weltermann, Institute for Family Medicine and General Practice, University of Bonn, Bonn, Germany.
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  • Gordon Taylor, Department for Health, University of Bath, Bath, UK.

OBJECTIVES: Cancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners' (PCPs') referral decisions is lacking.This study analyses health system factors potentially influencing PCPs' referral decision-making when consulting with patients who may have cancer, and how these vary between European countries.

DESIGN: Based on a content-validity consensus, a list of 45 items relating to a PCP's decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs' referral decision-making.

SETTING: A primary care study; 25 participating centres in 20 European countries.

PARTICIPANTS: 1830 PCPs completed the survey. The median response rate for participating centres was 20.7%.

OUTCOME MEASURES: The factors derived from items related to PCPs' referral decision-making. Mean factor scores were produced for each country, allowing comparisons.

RESULTS: Factor analysis identified five underlying factors: PCPs' ability to refer; degree of direct patient access to secondary care; PCPs' perceptions of being under pressure; expectations of PCPs' role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses.

CONCLUSIONS: Five healthcare system factors influencing PCPs' referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.

OriginalsprogEngelsk
TidsskriftBMJ Open
Vol/bind8
Nummer9
Sider (fra-til)e022904
ISSN2044-6055
DOI
StatusUdgivet - 5 sep. 2018

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