How health system factors affect primary care practitioners' decisions to refer patients for further investigation

Protocol for a pan-European ecological study

Michael Harris, Gordon Taylor

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Abstract

Background: There is wide variation in the overall one-year relative cancer survival rates across Europe, and this is thought to indicate national variations in stage of disease at diagnosis. However, there is little evidence to explain how different national systems influence a primary care practitioner's (PCP's) referral decisions, and how these relate to the variation in survival rates. This study investigates the health system factors that influence the thinking of PCPs when faced with patients who may have cancer, how they compare across European countries, and how they relate to national one-year relative cancer relative survival rates. Methods: An online quantitative questionnaire with closed-ended questions is used in a cross-sectional survey of 1250 PCPs in Europe, in 25 local health areas in 20 countries. Descriptive data are elicited for each country, including respondents' demographic details. An exploratory factor analysis will identify factors underlying the decision to refer patients for further investigations. Between-country variation in these factors will then be further investigated and presented as means with 95% confidence intervals. A regression model will be fitted for the vignettes using one-year relative survival as the outcome, with the proportion of PCPs opting to investigate as a single explanatory variable. Weighted regression will be used to explore which health system factors are associated with opting to investigate and with one-year relative survival. Linear correlations will be estimated between the proportions opting to investigate and national survival rates. When comparing between countries, weighted linear regression will be used to adjust for different sample sizes in each country. Discussion: This study investigates which system factors affect PCPs' decisions to refer and investigate patients who may have cancer, how they compare across 20 European countries, and how these factors relate to cancer survival rates. Knowledge of the extent and variability of the health system factors that affect referral decisions will inform future health service design, policy and research.

Original languageEnglish
Article number338
Pages (from-to)1-7
Number of pages7
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
Publication statusPublished - 8 May 2018

Fingerprint

Primary Health Care
Survival Rate
Health
Neoplasms
Referral and Consultation
Survival
Sample Size
Statistical Factor Analysis
Health Services
Linear Models
Research Design
Cross-Sectional Studies
Demography
Confidence Intervals
Surveys and Questionnaires

Keywords

  • Cancer
  • Decision making
  • Delivery of health care
  • Diagnosis
  • Primary health care
  • Survival
  • Cross-Sectional Studies
  • Humans
  • Survival Rate
  • Europe/epidemiology
  • Neoplasms/mortality
  • Government Programs
  • Referral and Consultation/statistics & numerical data
  • Surveys and Questionnaires
  • Primary Health Care
  • Research Design

ASJC Scopus subject areas

  • Health Policy

Cite this

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title = "How health system factors affect primary care practitioners' decisions to refer patients for further investigation: Protocol for a pan-European ecological study",
abstract = "Background: There is wide variation in the overall one-year relative cancer survival rates across Europe, and this is thought to indicate national variations in stage of disease at diagnosis. However, there is little evidence to explain how different national systems influence a primary care practitioner's (PCP's) referral decisions, and how these relate to the variation in survival rates. This study investigates the health system factors that influence the thinking of PCPs when faced with patients who may have cancer, how they compare across European countries, and how they relate to national one-year relative cancer relative survival rates. Methods: An online quantitative questionnaire with closed-ended questions is used in a cross-sectional survey of 1250 PCPs in Europe, in 25 local health areas in 20 countries. Descriptive data are elicited for each country, including respondents' demographic details. An exploratory factor analysis will identify factors underlying the decision to refer patients for further investigations. Between-country variation in these factors will then be further investigated and presented as means with 95{\%} confidence intervals. A regression model will be fitted for the vignettes using one-year relative survival as the outcome, with the proportion of PCPs opting to investigate as a single explanatory variable. Weighted regression will be used to explore which health system factors are associated with opting to investigate and with one-year relative survival. Linear correlations will be estimated between the proportions opting to investigate and national survival rates. When comparing between countries, weighted linear regression will be used to adjust for different sample sizes in each country. Discussion: This study investigates which system factors affect PCPs' decisions to refer and investigate patients who may have cancer, how they compare across 20 European countries, and how these factors relate to cancer survival rates. Knowledge of the extent and variability of the health system factors that affect referral decisions will inform future health service design, policy and research.",
keywords = "Cancer, Decision making, Delivery of health care, Diagnosis, Primary health care, Survival, Cross-Sectional Studies, Humans, Survival Rate, Europe/epidemiology, Neoplasms/mortality, Government Programs, Referral and Consultation/statistics & numerical data, Surveys and Questionnaires, Primary Health Care, Research Design",
author = "Michael Harris and Gordon Taylor",
year = "2018",
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day = "8",
doi = "10.1186/s12913-018-3170-2",
language = "English",
volume = "18",
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N2 - Background: There is wide variation in the overall one-year relative cancer survival rates across Europe, and this is thought to indicate national variations in stage of disease at diagnosis. However, there is little evidence to explain how different national systems influence a primary care practitioner's (PCP's) referral decisions, and how these relate to the variation in survival rates. This study investigates the health system factors that influence the thinking of PCPs when faced with patients who may have cancer, how they compare across European countries, and how they relate to national one-year relative cancer relative survival rates. Methods: An online quantitative questionnaire with closed-ended questions is used in a cross-sectional survey of 1250 PCPs in Europe, in 25 local health areas in 20 countries. Descriptive data are elicited for each country, including respondents' demographic details. An exploratory factor analysis will identify factors underlying the decision to refer patients for further investigations. Between-country variation in these factors will then be further investigated and presented as means with 95% confidence intervals. A regression model will be fitted for the vignettes using one-year relative survival as the outcome, with the proportion of PCPs opting to investigate as a single explanatory variable. Weighted regression will be used to explore which health system factors are associated with opting to investigate and with one-year relative survival. Linear correlations will be estimated between the proportions opting to investigate and national survival rates. When comparing between countries, weighted linear regression will be used to adjust for different sample sizes in each country. Discussion: This study investigates which system factors affect PCPs' decisions to refer and investigate patients who may have cancer, how they compare across 20 European countries, and how these factors relate to cancer survival rates. Knowledge of the extent and variability of the health system factors that affect referral decisions will inform future health service design, policy and research.

AB - Background: There is wide variation in the overall one-year relative cancer survival rates across Europe, and this is thought to indicate national variations in stage of disease at diagnosis. However, there is little evidence to explain how different national systems influence a primary care practitioner's (PCP's) referral decisions, and how these relate to the variation in survival rates. This study investigates the health system factors that influence the thinking of PCPs when faced with patients who may have cancer, how they compare across European countries, and how they relate to national one-year relative cancer relative survival rates. Methods: An online quantitative questionnaire with closed-ended questions is used in a cross-sectional survey of 1250 PCPs in Europe, in 25 local health areas in 20 countries. Descriptive data are elicited for each country, including respondents' demographic details. An exploratory factor analysis will identify factors underlying the decision to refer patients for further investigations. Between-country variation in these factors will then be further investigated and presented as means with 95% confidence intervals. A regression model will be fitted for the vignettes using one-year relative survival as the outcome, with the proportion of PCPs opting to investigate as a single explanatory variable. Weighted regression will be used to explore which health system factors are associated with opting to investigate and with one-year relative survival. Linear correlations will be estimated between the proportions opting to investigate and national survival rates. When comparing between countries, weighted linear regression will be used to adjust for different sample sizes in each country. Discussion: This study investigates which system factors affect PCPs' decisions to refer and investigate patients who may have cancer, how they compare across 20 European countries, and how these factors relate to cancer survival rates. Knowledge of the extent and variability of the health system factors that affect referral decisions will inform future health service design, policy and research.

KW - Cancer

KW - Decision making

KW - Delivery of health care

KW - Diagnosis

KW - Primary health care

KW - Survival

KW - Cross-Sectional Studies

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KW - Survival Rate

KW - Europe/epidemiology

KW - Neoplasms/mortality

KW - Government Programs

KW - Referral and Consultation/statistics & numerical data

KW - Surveys and Questionnaires

KW - Primary Health Care

KW - Research Design

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JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

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