Geographical access to GPs and modes of cancer diagnosis in England: a cross-sectional study
| Autor: | Andrew Jones, Max O Bachmann, Peninah Murage, S Michael Crawford, Sean McPhail |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Referral Cross-sectional study Health Services Accessibility Hospital records Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Neoplasms medicine Humans Registries 030212 general & internal medicine Aged Multinomial logistic regression Aged 80 and over Travel Primary Health Care business.industry 030503 health policy & services Cancer Middle Aged medicine.disease Cancer registry Cross-Sectional Studies Logistic Models England Relative risk Emergency medicine Female Emergency Service Hospital 0305 other medical science Family Practice Ovarian cancer business |
| Popis: | Background: Poor geographical access to health services and routes to a cancer diagnosis such as emergency presentations have previously been associated with worse cancer outcomes. However, the extent to which access to general practitioners (GPs) determines the route that patients take to obtain a cancer diagnosis is unknown. Methods: We used a linked dataset of cancer registry and hospital records of patients with a cancer diagnosis between 2006 and 2010 across eight different cancer sites. Primary outcomes were defined as ‘desirable routes to diagnosis’ (screen-detected and two week wait (TWW) referrals), and ‘less desirable routes’ (emergency presentations and death certificate only (DCO)). All other routes (GP Referral, Inpatient Elective and Other Outpatient) were specified as the reference category. Geographical access was measured as travel time in minutes from patients to their GP, and multinomial logistic regression was used to estimate Relative Risk Ratios (RRR). Results: Longer travel was associated with increased risk of diagnosis via emergency and DCO, but decreased risk of diagnosis via screening and TWW. Patients travelling over 30 minutes had the highest risk of a DCO diagnosis, which was statistically significant for breast, colorectal, lung, prostate, stomach and ovarian cancers (compared to patients with travel times < 10 minutes: RRR 5.89, 7.02, 2.30, 4.75, 10.41; p |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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