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在退伍军人选择计划实施后,前列腺癌的治疗位置和类型
Bradley A Erickson1,2, Richard M Hoffman1,3, Jason Wachsmuth1
1Veterans Health Administration (VHA) Office of Rural Health, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.
JAMA network open
|October 19, 2023
概括
退伍军人选择计划 (VCP) 增加了前列腺癌患者的社区护理 (CC),特别是远离VA设施的患者. 然而,这可能导致低风险前列腺癌的过度治疗.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 退伍军人选择计划 (VCP) 旨在通过购买社区护理 (CC) 改善退伍军人获得专业护理的机会.
- 了解VCP对前列腺癌治疗模式的影响对于优化医疗保健提供至关重要.
研究的目的:
- 分析VCP资助的前列腺癌退伍军人社区护理的流行率和模式.
- 评估VCP使用和治疗决策之间的关联,包括最终的治疗和护理环境.
主要方法:
- 一项队列研究利用了退伍军人卫生管理局 (VHA) 对2015-2018年间被诊断患有前列腺癌的退伍军人的行政数据.
- 治疗地点 (VHA与购买的CC) 通过分析活检,PSA检测和泌尿器科护理接触地点来确定.
- 结果包括接受终极治疗 (急性前列腺切除术,放射治疗) 和低风险前列腺癌的护理质量.
主要成果:
- 包括超过45,000名前列腺癌退伍军人;64.1%接受了最终治疗.
- 56.8%的最终治疗发生在购买的CC环境中,包括37.5%的激进前列腺切除术和66.7%的放射治疗.
- 对于居住在远离VHA设施的患者来说,观察到VCP使用率增加,购买CC的最终治疗率更高,包括低风险疾病.
结论:
- 在退伍军人中,VCP显著增加了用于前列腺癌治疗的购买社区护理的使用率.
- 在扩大接入的同时,VCP可能会导致低风险前列腺癌的潜在过度治疗,引发对护理质量的担忧.
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