Déterminants socio-géographiques de la prise en charge des cancers en France – Exemple des cancers colorectaux incidents entre 1997 et 2004 dans le département du Calvados

BackgroundNumerous studies have underlined an important deprivation gap in survival in all industrialized countries, prognosis being constantly poorer for the most deprived patients. Beside clinical factors, the explanation of this gap in survival could be partly explained by the influence of socio-geographical environment on cancer care management. The aim of this retrospective population-based study was to investigate the influence of socio-geographical determinants on access to a reference care centre.MethodsThe study population included all colorectal cancer patients with surgical treatment diagnosed between 1/01/1997 and 31/12/2004 in Calvados (n = 2318). Individual clinical data were supplied by the Calvados registry of the gastrointestinal tumors. Beside geographical variables (distance to nearest cancer center), aggregate socioeconomic data were derived from the last exhaustive census organized by the national statistics institute (INSEE) in 1999. The Townsend deprivation index was used for this study. Due to the hierarchical structure of such variables, a multilevel logistic model was used (Level 1: Patients; Level 2: IRIS2000).ResultsAfter adjustment on the individual variables, most remote patients were less frequently treated in a reference care center than those who were living near a reference care center (Odds Ratio adjust = 0.20 [0.15–0.28], p-trend < 0.001). Patients living in an IRIS2000 with high medical density were more likely to receive surgical treatment in a reference care centre (p-trend = 0.05). Townsend Deprivation index was not associated with access to reference care center.ConclusionAccess to a reference care center was strongly determined by the distance to nearest care center. Dissemination of clinical guidelines and improvement in treatment in non-reference care centers are crucial in ensuring equality in health care.     

Mise en place d’un programme de prévention et de prise en charge du diabète en Suisse : le point de vue des patients et des professionnels de la santé

BackgroundA reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the “Diabetes Cantonal Program”, within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate.MethodsWe organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis.ResultsPatients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients’ and professionals’ needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem.ConclusionThe identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.