Follow-up after curative treatment for breast cancer: Why do we still adhere to frequent outpatient clinic visits?

Abstract Background: People above age 65 are growing in many countries. Taiwan will be a super-aged society in 2026 and the utility of health care will increase considerably. Our study was aimed to evaluate the efficacy of the geriatric integrated outpatient clinic on health care utility reduction of the elderly. Methods: This was a retrospective case-control study. The patients with age more than 65 years old in the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri OPD) with age and sex-matched in a single medical center were included. The numbers of outpatient clinic visits, emergency department visits, hospitalization, and medical expenditure data were collected in the first year and second year. The subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years old) was done between Geri-OPD and non-Geri OPD. Results: Total 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years old. There were 1291 (19.2%) patients from the Geri-OPD and 5432 (80.8%) patients from the non-Geri OPD. After one year regular follow-up, those Geri-OPD patients had significantly reduced 5.62±10.85 kinds of drugs in each prescription and 18.18 ± 48.85 clinic visits per year (P<0.01). After two-year follow-up, the clinic visits, emergent department visits, hospitalizations, and the annual medical cost still decreased in the Geri-OPD patients. The Geri-OPD patients have more co-morbidities and higher health care utility than the non-Geri OPD patients. In the subgroup analysis, the patients with higher comorbidities (CCI≧2) and older age (≧80 years old) have significant health care utility reduction in Geri-OPD. The medical utility difference between the Geri-OPD and non-Geri OPD patients also decreased significantly. Conclusion: The geriatric integrated outpatient clinic reduced the medical cost, drug numbers, and the frequency of outpatient clinic visit, emergency department visit and hospitalization in the complicated elder patients. The effect was even better in the second year.

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Are PROMs sufficient to record late outcome of breast cancer patients treated with radiotherapy? A comparison between patient and clinician reported outcome through an outpatient clinic after 10 years of follow up

Radiotherapy and Oncology ◽

10.1016/j.radonc.2017.08.004 ◽

2018 ◽

Vol 126 (1) ◽

pp. 163-169 ◽

Cited By ~ 5

Author(s):

P.J.A.M. Brouwers ◽

J. van Loon ◽

R.M.A. Houben ◽

J. Paulissen ◽

S.M.E. Engelen ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Outpatient Clinic ◽

Breast Cancer Patients ◽

Late Outcome

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The influence of integrated geriatric outpatient clinics on the health care utility of older people

10.21203/rs.2.21639/v4 ◽

2020 ◽

Author(s):

Yu-Ju Wei ◽

Cheng-Fang Hsieh ◽

Yu-Ting Huang ◽

Ming-Shyan Huang ◽

Tzu-Jung Fang

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Older People ◽

Outpatient Clinic ◽

Emergency Department Visits ◽

Care Utilization ◽

Second Year ◽

Clinic Visits

Abstract Background: The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people.Methods: This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups.Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients.Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

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Improving the efficiency and quality of follow-up after curative treatment for breast cancer

http://isrctn.org/> ◽

10.1186/isrctn74071417 ◽

2012 ◽

Author(s):

L J Boersma

Keyword(s):

Breast Cancer ◽

Curative Treatment

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Patient satisfaction with nurse-led telephone follow-up after curative treatment for breast cancer

BMC Cancer ◽

10.1186/1471-2407-10-174 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 60

Author(s):

Merel L Kimman ◽

Monique MF Bloebaum ◽

Carmen D Dirksen ◽

Ruud MA Houben ◽

Philippe Lambin ◽

...

Keyword(s):

Breast Cancer ◽

Patient Satisfaction ◽

Curative Treatment

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Frailty status changes are associated with healthcare utilization and subsequent mortality in the elderly population

BMC Public Health ◽

10.1186/s12889-021-10688-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chia-Ming Li ◽

Chih-Hsueh Lin ◽

Chia-Ing Li ◽

Chiu-Shong Liu ◽

Wen-Yuan Lin ◽

...

Keyword(s):

Healthcare Utilization ◽

Outpatient Clinic ◽

Reference Group ◽

National Database ◽

Care Utilization ◽

Frailty Phenotype ◽

Frailty Status ◽

Outpatient Visits ◽

Clinic Visits

Abstract Background This study determined (1) whether a change in frailty status after a 1 year follow up is associated with healthcare utilization and evaluated (2) whether a change in frailty status after a 1 year follow up and health care utilization are associated with all-cause mortality in a sample of Taiwan population. Methods This work is a population-based prospective cohort study involving residents aged ≥65 years in 2009. A total of 548 elderly patients who received follow-ups in the subsequent year were included in the current data analysis. Fried frailty phenotype was measured at baseline and 1 year. Information on the outpatient visits of each specialty doctor, emergency care utilization, and hospital admission during the 2 month period before the second interview was collected through standardized questionnaires administered by an interviewer. Deaths were verified by indexing to the national database of deaths. Results At the subsequent 1 year follow-up, 73 (13.3%), 356 (64.9%), and 119 (21.7%) elderly participants exhibited deterioration, no change in status, and improvement in frailty states, respectively. Multivariate logistic analysis showed the high risk of any type of outpatient use (odds ratios [OR] 1.94, 95% confidence interval [CI] 1.02–3.71) among older adults with worse frailty status compared with those who were robust at baseline and had unchanged frailty status after 1 year. After multivariate adjustment, participants with high outpatient clinic utilization had significantly higher mortality than those with low outpatient clinic visits among unchanged pre-frail or frail (hazard ratios [HR] 2.79, 95% CI: 1.46–5.33) and frail to pre-frail/robust group (HR 9.32, 95% CI: 3.82–22.73) if the unchanged robustness and low outpatient clinic visits group was used as the reference group. Conclusions The conditions associated with frailty status, either after 1 year or at baseline, significantly affected the outpatient visits and may have increased medical expenditures. Combined change in frailty status and number of outpatient visits is related to increased mortality.

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