Geographical access to GPs and modes of cancer diagnosis in England: a cross-sectional study

Murage, Peninah, Bachmann, Max O., Crawford, S. Michael, McPhail, Sean and Jones, Andy (2018) Geographical access to GPs and modes of cancer diagnosis in England: a cross-sectional study. Family Practice. ISSN 0263-2136

[img] PDF (Accepted manuscript) - Submitted Version
Restricted to Repository staff only until 19 November 2019.

Download (450kB) | Request a copy


    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<0.01 and 3.51, p<0.05). Discussion: Poor access to general practitioners may discourage early engagement with health services, decreasing the likelihood of screening uptake, and increasing the likelihood of emergency presentations. Extra effort is needed to promote early diagnosis in more distant patients.

    Item Type: Article
    Uncontrolled Keywords: early diagnosis,emergency admissions,health services accessibility,primary health care,screening
    Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
    Depositing User: LivePure Connector
    Date Deposited: 24 Jul 2018 14:33
    Last Modified: 11 Apr 2019 15:57
    DOI: 10.1093/fampra/cmy077

    Actions (login required)

    View Item