Patients at elevated risk of melanoma: Individual predictors of non-compliance to GP referral for a dermatologist consultation
Menée à partir d'une enquête auprès de 1 506 patients présentant un risque élevé de développer un mélanome et ayant été dirigé vers un dermatologue par un médecin généraliste, cette étude française identifie les facteurs associés au non respect de la prescription
Objective : The aim of this study is to assess whether patients at elevated risk of melanoma attended a dermatologist consultation after a GP referral and to determine individual predictors of non-compliance. Method : This survey included 1506 high-risk French patients (selected using the Self-Assessment Melanoma Risk Score) referred to a dermatologist between April and October 2011. Compliance was evaluated from January to April 2012, based on attendance at a dermatologist consultation (or scheduling an appointment). Demographic data and factors mapping the Health Belief Model were tested as correlates using a multivariate logistic regression. Results : Compliance with referral was 58.4%. The top seven factors associated with non-compliance were as follows: GP advice to consult was unclear (OR = 13.22; [7.66–23.56]); no previous participation in cancer screenings, including smear tests (OR = 5.03; [2.23–11.83]) and prostate screening (OR = 2.04; [1.06–3.97]); lack of knowledge that melanoma was a type of cancer (OR = 1.94; [1.29–2.92]); and reporting no time to make an appointment (OR = 2.08; [1.82–2.38]), forgetting to make an appointment (OR = 1.26; [1.08–1.46]), long delays in accessing an appointment (OR = 1.25; [1.12–1.41]), not being afraid of detecting something abnormal (OR = 1.54; [1.35–1.78]), no need to consult a dermatologist to feel secure (OR = 1.28; [1.09–1.51]). Conclusion : Physicians should be aware of the factors predicting patient compliance with referrals for dermatologist consultations; better GP counseling might enhance compliance in high-risk populations.
Preventive Medicine 2014