Follow-up of cancer in primary care versus secondary care: systematic review
Follow-up of cancer in primary care versus secondary care: systematic review
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DOI：
10.3399/bjgp09x453567
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发表时间：
2009-07-01
影响因子：
5.9
通讯作者：
Wilkinson, Clare
中科院分区：
文献类型：
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作者：
Lewis, Ruth A.;Neal, Richard D.;Wilkinson, Clare
背景癌症随访传统上是在二级保健中进行的，但越来越多的人呼吁在初级保健中提供它。目的比较初级保健与二级保健对癌症患者随访的有效性和成本效益，确定初级保健在常规医院随访中的整合效果，并评估患者发起的随访对初级保健的影响。研究设计系统综述。设置初级和二级保健设置。方法对19个电子数据库，在线试验注册，会议记录和所包含研究的参考书目。该综述包括比较研究或初级与二级护理随访的经济评估，正式初级护理参与的医院随访与传统医院随访，以及医院随访与患者发起或最小随访的比较，如果研究报告了对初级保健的影响。复发相关严重临床事件、诊断延迟或患者满意度。GP引导的乳腺癌随访比医院随访便宜。强化初级卫生保健导致家庭护理护士接触增加，改善出院总结导致GP接触增加。患者发起的或最低限度的后续评估发现没有统计学上的显着影响GP咨询或癌症相关referreration.Conclusion弱证据表明，乳腺癌的后续工作在初级保健的数量是有效的。改善初级和二级保健之间沟通的干预措施可能会导致更多的GP参与。停止正式随访可能不会增加GP的工作量。然而，数据的质量总体上很差，无法得出确切的结论。
Background Cancer follow-up has traditionally been undertaken in secondary care, but there are increasing calls to deliver it in primary care.Aim To compare the effectiveness and cost-effectiveness of primary versus secondary care follow-up of cancer patients, determine the effectiveness of the integration of primary care in routine hospital follow-up, and evaluate the impact of patient-initiated follow-up on primary care.Design of study Systematic review.Setting Primary and secondary care settings.Method A search was carried out of 19 electronic databases, online trial registries, conference proceedings, and bibliographies of included studies. The review included comparative studies or economic evaluations of primary versus secondary care follow-up, hospital follow-up with formal primary care involvement versus conventional hospital follow-up, and hospital follow-up versus patient-initiated or minimal follow-up if the study reported the impact on primary care.Results There was no statistically significant difference for patient wellbeing, recurrence rate, survival, recurrence-related serious clinical events, diagnostic delay, or patient satisfaction. GP-led breast cancer follow-up was cheaper than hospital follow-up. Intensified primary health care resulted in increased home-care nurse contact, and improved discharge summary led to increased GP contact. Evaluation of patient-initiated or minimal follow-up found no statistically significant impact on the number of GP consultations or cancer-related referrals.Conclusion Weak evidence suggests that breast cancer follow-up in primary care is effective. Interventions improving communication between primary and secondary care could lead to greater GP involvement. Discontinuation of formal follow-up may not increase GP workload. However, the quality of the data in general was poor, and no firm conclusions can be reached.