Link between the referring physician and breast and cervical cancers screening: a cross-sectional study in France

Abstract

Background: The aims of the "médecin traitant" or referring physician (RP) reform, introduced in France in 2004, were to improve the organisation and quality of care and to allow for greater equity, particularly in terms of prevention. The objective of our study was to evaluate the effect of having a declared RP on the uptake of screening for breast and cervical cancers, and to explore the mechanisms involved.

Methods: We used an existing dataset of 1,072,289 women, which combines data from the Health Insurance information systems, with census data. We built multivariable logistic regression models to study the effect of having a RP on the uptake of mammography and pap smear, adjusted for age, socio-economic level, health status and healthcare provision. We secondarily added to this model the variable "having consulted a General Practitioner (GP) within the year". Finally, we evaluated the interaction between the effect of having a referring physician and the area of residence (metropolitan/urban/rural).

Results: Patients who had a declared RP had a significantly higher uptake of mammography and pap smear than those who did not. The strength of the association was particularly important in very urban areas. The effect of having visited a GP seemed to explain a part of the correlation between having a RP and uptake of screening.

Conclusions: Lower rates of gynaecological screening among women without an RP compared to those with an RP may partly reflect a specific behaviour pattern in women less adherent to the health care system. However, this result also shows the importance of the RP, who assumes the key role of relaying public health information in a more personalised and adapted way.

Keywords: Breast neoplasms; Continuity of patient care; Early detection of cancer; General practitioners; Socioeconomic factors; Uterine cervical neoplasms.

Fig. 1

Flow chart. Identification of study populations A, B and C

Fig. 2

Conceptual model: Links between the studied variables assumed to explain the impact of “having an RP” on the uptake of screening, depending on the level of urbanisation

Fig. 3

Determinants influencing the designation of a Referring Physician in Midi Pyrénées (2012): multivariable logistic regression model. Adjusted on age, long-term condition (ALD), EDI, GP PLA and level of urbanisation In population A: women over 16 years old (n = 1,072,289)