ObjectivesCancer 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.DesignBased 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.SettingA primary care study; 25 participating centres in 20 European countries.Participants1830 PCPs completed the survey. The median response rate for participating centres was 20.7%.Outcome measuresThe factors derived from items related to PCPs’ referral decision-making. Mean factor scores were produced for each country, allowing comparisons.ResultsFactor 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.ConclusionsFive 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.

BackgroundNational European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis.ObjectivesThis study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagnosis could be improved.DesignIn an online survey, a final open-ended question asked PCPs how they thought the speed of diagnosis of cancer in primary care could be improved. Thematic analysis was used to analyse the data.SettingA primary care study, with participating centres in 20 European countries.ParticipantsA total of 1352 PCPs answered the final survey question, with a median of 48 per country.ResultsThe main themes identified were: patient-related factors, including health education; care provider-related factors, including continuing medical education; improving communication and interprofessional partnership, particularly between primary and secondary care; factors relating to health system organisation and policies, including improving access to healthcare; easier primary care access to diagnostic tests; and use of information technology. Re-allocation of funding to support timely diagnosis was seen as an issue affecting all of these.ConclusionsTo achieve more timely cancer diagnosis, health systems need to facilitate earlier patient presentation through education and better access to care, have well-educated clinicians with good access to investigations and better information technology, and adequate primary care cancer diagnostic pathway funding.

Esenţa specialităţii de medicină de familie rămâne posibilitatea de a monitoriza starea de sănătate a întregii familii; de la gravidă la copil, de la tânăr la senior, de la starea de sănătate la starea de boală, de la intervenţii de tip preventiv la cele terapeutice. Medicul de familie (MF) are în îngrijire două sau chiar trei generaţii ale aceleiaşi familii, vine în contact cu fiecare membru din familie, pe parcursul multor ani de practică medicală. Monitorizarea clinică va permite întocmirea unei „hărţi a factorilor de risc“ (HFR), bazată pe patologia familiei de origine. Analizând HFR şi factorii de risc majori identificaţi care acţionează în interiorul familiei, MF poate genera un model predictiv intrafamilial (MPI). MF are posibilitatea aplicării unor intervenţii educative personalizate eficiente, adresate întregii familii. Acest tip de intervenţie aplicat în copilăria timpurie poate încetini sau întârzia apariţia şi evoluţia bolilor cronice grave. În esenţă, MPI reprezintă un mecanism de intervenţie preventivă precoce în controlul apariţiei bolilor cronice majore la viitorii adulţi.

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The essence of the family medicine specialty remains surveillance of the health for the whole family: from pregnancy to child, from young to senior, from health to disease, from preventive to therapeutic interventions. The family doctor (GP) carries on two or even three generations of the same family, comes in contact with each family member, during many years of medical practice. The continuous clinical monitoring, will allow preparation of a “Risk Factors Map” (RFM). RFM is based on the high risk chronical pathology faced by a family over generations. Analyzing RFM and identifying major risk factors that act inside the family, GP can generate an intrafamilial predictive model (IPM). Having under medical care the whole family, developing in time a relationship of trust with the patients, based on serious professional training, armed with good communication skills, GP has the possibility to implement personalized educational interventions inside the family for life style changing. This kind of intervention applied in early childhood, can slow down or delay the appearance and the evolution of the severe chronical diseases. In essence, IPM is an early preventive interventional mechanism in controlling the occurrence of major chronic diseases in future adults.