TY - JOUR
T1 - How the probability of presentation to a primary care clinician correlates with cancer survival rates
T2 - a European survey using vignettes
AU - Harris, Michael
AU - Frey, Peter
AU - Esteva, Magdalena
AU - Gašparović Babić, Svjetlana
AU - Marzo-Castillejo, Mercè
AU - Petek, Davorina
AU - Petek Ster, Marija
AU - Thulesius, Hans
PY - 2017/1/2
Y1 - 2017/1/2
N2 - 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 POINTS European 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.
AB - 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 POINTS European 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.
KW - cancer
KW - decision making
KW - diagnosis
KW - Europe
KW - Health care systems
KW - primary health care
UR - http://www.scopus.com/inward/record.url?scp=85014571071&partnerID=8YFLogxK
UR - http://dx.doi.org/10.1080/02813432.2017.1288692
UR - http://dx.doi.org/10.1080/02813432.2017.1288692
U2 - 10.1080/02813432.2017.1288692
DO - 10.1080/02813432.2017.1288692
M3 - Article
AN - SCOPUS:85014571071
SN - 0281-3432
VL - 35
SP - 27
EP - 34
JO - Scandinavian Journal of Primary Health Care
JF - Scandinavian Journal of Primary Health Care
IS - 1
ER -