Treatment and Follow-up Care Associated With Patient-Scheduled Primary Care Telemedicine and In-Person Visits in a Large Integrated Health System

105 Background: Previous research using nationally representative data showed significant differences between primary care physician (PCP) and oncologists’ attitudes and practices with respect to care of cancer survivors and called for more effective communication and coordination to improve care. This study compared PCP and oncologists’ attitudes and practices for follow-up cancer care within an integrated health system sharing a common electronic health record and clinical infrastructure to examine whether the integrated setting facilitated communication and coordination between PCPs and oncologists. Methods: 41 PCPs and 24 oncologists (response rate = 52%) affiliated with an integrated safety-net health system completed a validated survey. The survey assessed PCP and oncologists’ preferred models for delivering care, attitudes towards follow-up care, and cancer surveillance practices in this setting. Results: 41% of PCPs preferred an oncologist-led care delivery model as compared to 21% of oncologists. More PCPs than oncologists (73% vs 58%) agreed that PCPs have the skills necessary to initiate cancer surveillance. Yet, PCPs more often disagreed (56% vs 42% of oncologists) that they should have primary responsibility for providing cancer follow-up care. PCPs and oncologists differed significantly over cancer surveillance practices. Oncologists more consistently reported that PCPs ordered tests for cancer surveillance, evaluated patients for cancer recurrence and for adverse physical and psychological effects of cancer or its treatment, as well as managed pain and adverse outcomes of cancer treatment. PCPs, however, did not report equivalent ordering for these services. Conclusions: Even within an integrated health system, we found significant uncertainty as to who is responsible for care of cancer survivors. Oncologists more commonly assigned responsibility for cancer survivorship care to PCPs than PCPs recognized. This imbalance indicates many cancer survivors may not be receiving recommended care. Consensus guidelines are needed to delineate shared responsibilities for cancer survivors between primary care and oncology specialty care physicians.

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Minimally Adequate Mental Health Treatment and Mortality in Primary Care Older Adults With Depression and Anxiety

Innovation in Aging ◽

10.1093/geroni/igab046.3128 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 864-865

Author(s):

Helen-Maria Vasiliadis ◽

Catherine Lamoureux-Lamarche ◽

Sébastien Grenier ◽

Pasquale Roberge

Keyword(s):

Mental Health ◽

Older Adults ◽

Primary Care ◽

Health System ◽

Emergency Department Visits ◽

Adequate Treatment ◽

Risk Of Mortality ◽

Follow Up Care ◽

System Factors

Abstract Receipt of quality mental health (MH) care can influence mortality. Given the scarce literature on the topic, the aim was to assess the 3-year risk of mortality in older adults (OA) associated with receiving adequate MH treatment for depression/anxiety in an epidemiologic context. The study sample included 358 OA with depression/anxiety recruited in primary care practices and followed prospectively for 3 years. Mortality was assessed from vital statistics data. Adequate care was based on receipt of pharmacotherapy, follow-up care and psychotherapy. Propensity score analysis was carried out where the inverse probability (IPW) of receiving adequate treatment was calculated. Time to event analyses with IPW was used to assess the effect of receipt of adequate MH treatment on the risk of mortality controlling for individual and health system factors. The results showed that receipt of adequate MH treatment reduced the risk of mortality (HR0.44; 95% CI: 0.22 – 0.99). Individual factors that increased mortality were male sex, being single, reduced functional status and cognitive functioning, # physical disorders, current smoking; while exercise reduced risk. Health system factors such as past # of hospitalizations increased the risk; while # of emergency department visits and continuity of care reduced mortality. Finally, treating depression/anxiety with minimal follow-up care and pharmacotherapy or psychotherapy has a significant impact on reducing mortality in OA. Primary care physicians should recognize the important potential impact of years of lives saved when providing quality MH care to OA.

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Preventable readmissions and physician notification

Journal of Hospital Administration ◽

10.5430/jha.v3n1p1 ◽

2013 ◽

Vol 3 (1) ◽

pp. 1

Author(s):

Daniel Kazzaz

Keyword(s):

Primary Care ◽

Health System ◽

Hospital Readmissions ◽

National Standards ◽

Follow Up Care

Preventable hospital readmissions burden our health system with excessive costs. The key to reducing readmissions is appropriate follow-up care for patients upon discharge. Many patients today do not receive necessary follow-up care for the simple reason that their primary care and specialist physicians are not made aware of the hospitalization. A simple and scalable solution is needed to provide automatic notifications to physicians when their patients are admitted to and discharged from hospitals. Such systems, based on national standards for universal adoption, are emerging in several forms, making headway in reducing preventable hospital readmissions.

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An evaluation of the breast cancer Well Follow-up Care Initiative using administrative databases: A new model of analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.1 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 1-1

Author(s):

Nicole Mittmann ◽

Craig Earle ◽

Hasmik Beglaryan ◽

Ning Liu ◽

Julie Gilbert ◽

...

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Health System ◽

Primary Care Providers ◽

Administrative Databases ◽

Care Providers ◽

Significant Difference ◽

Follow Up Care ◽

System Resources

1 Background: Cancer Care Ontario (CCO) implemented the Well Follow-up Care Initiative (WFCI) to transition low-risk breast cancer (BC) survivors from oncologist to primary care providers. The objective of this work was to compare both the health system resources utilized and their associated costs, among women in the WFCI (cases) and women who were not transitioned (controls). Methods: Cases were linked to provincial administrative databases and matched to a control group based on year of diagnosis, cancer stage, age, comorbidity, income, geographic area of residence, and prior health system use. Health system resource utilization (physician, hospitalization, diagnostics, medication, and homecare) was ascertained per group. The annual mean and median costs (CAD 2014) per patient were determined. Annualized incremental costs between cases and controls were estimated using generalized estimating equations, accounting for matched pairs. Results: Results are based on 2,324 cases and 2,324 controls (mean age 64.4 and 64.9 years, respectively). During an average of 2.5 years of follow-up since the transition date, there were significant differences between the two groups for mean annual visits per patient with a medical oncologist (0.4 vs. 1.3, p<0.001) and radiation oncologist (0.2 vs. 0.4, p<0.001). There was no significant difference in mean annual family physician visits per patient (7.4 vs. 7.9, p=0.082). The intervention group had fewer inpatient hospitalizations (75.6% vs. 79.9%) and cancer clinic visits (84.9% vs. 94.0%). While there was a higher number of mammograms for cases compared to controls, other diagnostic tests (bone scan, CT, MRI, ultrasound, and x-rays) were done less frequently. The model was associated with a 39.3% reduction in mean annual costs ($6,575 among cases and $10,832 among controls) and a 22.1% reduction in median annual costs ($2,261 among cases and $2,903 among controls). Conclusions: Transitioning BC survivors to primary care was associated with fewer health system resources and had a lower annual mean cost per patient than women who were not transitioned.

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Factors Associated with Meeting the Psychosocial Needs of Cancer Survivors in Nova Scotia, Canada

Current Oncology ◽

10.3390/curroncol28010004 ◽

2020 ◽

Vol 28 (1) ◽

pp. 13-25

Author(s):

Soleil Chahine ◽

Gordon Walsh ◽

Robin Urquhart

Keyword(s):

Primary Care ◽

Nova Scotia ◽

Cancer Survivors ◽

Sociodemographic Factors ◽

Patient Navigator ◽

Care Providers ◽

Psychosocial Needs ◽

Factors Associated ◽

Follow Up Care

Purpose: The purpose of this study is to describe the psychosocial needs of cancer survivors and examine whether sociodemographic factors and health care providers accessed are associated with needs being met. Methods: All Nova Scotia survivors meeting specific inclusion and exclusion criteria are identified from the Nova Scotia Cancer Registry and sent an 83-item survey to assess psychosocial concerns and whether and how their needs were met. Descriptive statistics (frequencies, percentages) and Chi-square analyses are used to examine associations between sociodemographic and provider factors and outcomes. Results: Anxiety and fear of recurrence, depression, and changes in sexual intimacy are major areas of concern for survivors. Various sociodemographic factors, such as immigration status, education, employment, and internet use, are associated with reported psychosocial health and having one’s needs met. Having both a specialist and primary care provider in charge of follow-up care is associated with a significantly (p < 0.05) higher degree of psychosocial and informational needs met compared to only one physician or no follow-up physician in charge. Accessing a patient navigator also is significantly associated with a higher degree of needs met. Conclusions: Our study identifies the most prevalent psychosocial needs of cancer survivors and the factors associated with having a higher degree of needs met, including certain sociodemographic factors, follow-up care by both a primary care practitioner and specialist, and accessing a patient navigator.

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Follow-up care of children identified with ADHD by primary care clinicians: A prospective cohort study

The Journal of Pediatrics ◽

10.1016/j.jpeds.2004.08.028 ◽

2004 ◽

Vol 145 (6) ◽

pp. 767-771 ◽

Cited By ~ 28

Author(s):

William Gardner ◽

Kelly J. Kelleher ◽

Kathleen Pajer ◽

John V. Campo

Keyword(s):

Primary Care ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Follow Up Care ◽

Primary Care Clinicians

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Measuring follow-up care between primary care and specialty behavioral health settings for children and adolescents

Social Work in Mental Health ◽

10.1080/15332985.2019.1617224 ◽

2019 ◽

Vol 17 (5) ◽

pp. 627-638 ◽

Cited By ~ 1

Author(s):

Sean Lynch ◽

Whitney Witt ◽

Mir M. Ali ◽

Judith Teich ◽

Ryan Mutter ◽

...

Keyword(s):

Primary Care ◽

Children And Adolescents ◽

Behavioral Health ◽

Follow Up Care

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A Decision Support System (DSS) for Colorectal Cancer Follow-Up Program via a Semantic Framework

International Journal of Healthcare Information Systems and Informatics ◽

10.4018/ijhisi.2015010102 ◽

2015 ◽

Vol 10 (1) ◽

pp. 17-38 ◽

Cited By ~ 4

Author(s):

Kalpdrum Passi ◽

Hongtao Zhao

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Decision Support ◽

Cancer Patients ◽

Support System ◽

Web Application ◽

Semantic Framework ◽

Follow Up Care ◽

The Web

This paper offers insights into evolving a decision support system (DSS) to aid primary care physicians and/or nurses in the post-surgical care of patients with Colorectal Cancer in a clinical setting. Presently, the oncologists in the cancer center, who are familiar with the Clinical Practice Guidelines (CPGs), are primarily responsible for the provision of follow-up care to their patients on the basis of the CPGs; in contrast, the attending primary care physician and/or nurse assisting the oncologist may be unfamiliar with these guidelines. These caregivers would, therefore, either require hardcopies of the CPGs or can be aided via a DSS for them to be able to provide the appropriate follow-up care for the respective cancer patients. Clearly, the Colorectal Cancer follow-up CPGs have to be analyzed and the ontology representing the knowledge embedded in the guidelines designed prior to realizing such a DSS. The designed ontology is often coded into Web Ontology Language (OWL) as a standard ontology that can be accessed through the Web. The authors' research team designed and presented the semantic framework of the web application, using the designed ontology that combines the current Web technology with database storage to achieve a unified development of the DSS. The authors also designed a user-friendly interface of the Web application to provide medical practitioners the functionality of the CPGs and the flexibility to customize the desired follow-up care schedule. The resulting DSS provides the physicians with follow-up program for the Colorectal Cancer patients based on the CPGs. The system was built using the semantic framework for the follow-up program and queries on the system are executed through SPARQL query engine.

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