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Secondary care intervals before and after the introduction of urgent referral guidelines for suspected cancer in Denmark: a comparative before-after study

Mette Bach Larsen123*, Rikke Pilegaard Hansen13, Dorte Gilså Hansen4, Frede Olesen13 and Peter Vedsted13

Author affiliations

1 Research Unit for General Practice, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark

2 Section for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark

3 Centre for Cancer Diagnosis in Primary Care – CaP, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark

4 National Research Centre for Cancer Rehabilitation, Research Unit for General Practice, University of Southern Denmark, J.B. Winsløws vej 9, DK-5000 Odense C, Denmark

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Citation and License

BMC Health Services Research 2013, 13:348  doi:10.1186/1472-6963-13-348

Published: 10 September 2013



Urgent referral for suspected cancer was implemented in Denmark on 1 April 2008 to reduce the secondary care interval (i.e. the time interval from the general practitioner’s first referral of a patient to secondary health care until treatment is initiated). However, knowledge about the association between the secondary care interval and urgent referral remains scarce. The aim of this study was to analyse how the secondary care interval changed after the introduction of urgent referral.


This was a retrospective population-based study of 6,518 incident cancer patients based on questionnaire data from the patients’ GPs. Analyses were stratified with patients discharged from Vejle Hospital in one stratum and patients from other hospitals in another because Vejle Hospital initiated urgent referrals several years prior to the national implementation. Further, analyses were stratified according to symptom presentation and whether or not the GP referred the patient on suspicion of cancer. Symptom presentation was defined as with or without alarm symptoms based on GP interpretation of early symptoms.


The median secondary care interval decreased after the introduction of urgent referral. Patients discharged from Vejle Hospital tended to have shorter secondary care intervals than patients discharged from other hospitals. The strongest effect was seen in patients with alarm symptoms and those who were referred by their GP on suspicion of cancer. Breast cancer patients from Vejle Hospital experienced an even shorter secondary care interval after the national introduction of urgent referrals.


Urgent referral had a positive effect on the secondary care interval, and Vejle Hospital remarkably managed to shorten the intervals even further. This finding indicates that the shorter secondary care intervals not only result from the urgent referral guidelines, but also involve other factors.

Denmark; Early detection of cancer; Family practice; Health services administration