Primary Care

2019 ◽  
pp. 194-200
Author(s):  
Inge Kriel ◽  
Geertruida de Bock ◽  
Sabine Siesling ◽  
Annette Berendsen
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Patient Management ◽  
The Elderly ◽  
Care Physician ◽  
Survivorship Care ◽  
Breast Cancer Patients ◽  
Care For The Elderly ◽  
The Family

Abstract: Primary care physicians play a vitally important role in care and in the management of patients with breast cancer in any setting, but their contribution is especially valuable in a developing country setting. Communication between the family physician and the specialist ensures holistic patient management. Whereas the specialist focuses on management of the breast cancer, the generalist assesses and manages the complex interplay between pre-existing chronic medical conditions and the breast cancer. The biopsychosocial model is the cornerstone of general practice. The primary care physician plays an important role in managing breast cancer patients in all phases of the disease: prediagnosis, diagnosis, during treatment, after-treatment survivorship care, care for the elderly, and palliative care.

Delivery of Survivorship Care by Primary Care Physicians: The Perspective of Breast Cancer Patients

2009 ◽  
Vol 27 (6) ◽  
pp. 933-938 ◽  
Author(s):  
Jun J. Mao ◽  
Marjorie A. Bowman ◽  
Carrie T. Stricker ◽  
Angela DeMichele ◽  
Linda Jacobs ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Multivariate Regression ◽  
Care Delivery ◽  
Postmenopausal Breast Cancer ◽  
The United States ◽  
Cancer Therapies ◽  
Survivorship Care ◽  
General Care

Purpose Most of the 182,460 women diagnosed with breast cancer in the United States this year will become long-term survivors. Helping these women transition from active treatment to survivorship is a challenge that involves both oncologists and primary care physicians (PCPs). This study aims to describe postmenopausal breast cancer survivors' (BCS) perceptions of PCP-related survivorship care. Patients and Methods We conducted a cross-sectional survey of 300 BCSs seen in an outpatient breast oncology clinic at a large university hospital. The primary outcome measure was a seven-item self-reported measure on perceived survivorship care (Cronbach's α = .89). Multivariate regression analyses were used to identify factors associated with perceived care delivery. Results Overall, BCSs rated PCP-related survivorship care as 65 out of 100 (standard deviation = 17). The areas of PCP-related care most strongly endorsed were general care (78%), psychosocial support (73%), and health promotion (73%). Fewer BCSs perceived their PCPs as knowledgeable about cancer follow-up (50%), late effects of cancer therapies (59%), or treating symptoms related to cancer or cancer therapies (41%). Only 28% felt that their PCPs and oncologists communicated well. In a multivariate regression analysis, nonwhite race and level of trust in the PCP were significantly associated with higher perceived level of PCP-related survivorship care (P = .001 for both). Conclusion Although BCSs perceived high quality of general care provided by their PCPs, they were not as confident with their PCPs' ability to deliver cancer-specific survivorship care. Interventions need to be tested to improve oncology-primary care communication and PCP knowledge of cancer-specific survivorship care.

Is Primary Care Physician Supply Correlated with Health Outcomes?

1998 ◽  
Vol 28 (1) ◽  
pp. 183-196 ◽  
Author(s):  
Robert L. Vogel ◽  
Richard J. Ackermann
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Canonical Correlation ◽  
Primary Care Physicians ◽  
The Elderly ◽  
Complex Problem ◽  
Care Physician ◽  
Physician Supply ◽  
Specialist Physician ◽  
Wide Range

Assessment of the relation between life indicators and health outcomes is a complex problem. The authors' analysis uses descriptive canonical correlation, and their solution suggests that socioeconomic factors play a major role in health outcomes. The supply of primary care physicians has a lesser but still important role: canonical correlation suggests no apparent role in enhancing health outcomes among the elderly but a larger role in improving health among the young. The authors' analysis does support the notion that specialist physician supply has no correlation with a wide range of health outcomes.

Health after cancer: Early patient experience in a pilot survivorship clinic embedded in primary care.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 180-180
Author(s):  
Lidia Schapira ◽  
Marcy Winget ◽  
Siqi WU ◽  
Jennifer Kim ◽  
Cati Brown-Johnson
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Cancer Survivorship ◽  
Primary Care Physicians ◽  
Expert Knowledge ◽  
Primary Care Clinic ◽  
Breast Cancer Patients ◽  
Care Clinic

180 Background: Prior research has identified barriers to provision of quality survivorship care in primary care settings such as lack of expert knowledge and training, primary care burden and insufficient communication with oncologists. We implemented a survivorship clinic at an academic medical center in the primary care division with the goal of defining the elements required for a seamless transition and co-management. Methods: The primary care physician received training in cancer survivorship based on the ASCO Curriculum, shadowing of 3 breast medical oncologists and 1 gynecologic oncologist, attendance at the 2018 Cancer Survivorship Symposium and NCCN’s Cancer Survivorship Advocacy Meeting. Patients with breast and gynecologic cancers were referred by their oncologists or APP (PA or NP) at various points in their cancer trajectory. Clinical characteristics of patients were abstracted from the electronic medical record and in-depth interviews were conducted with 2 patients. Results: 41 patients attended the survivorship clinic. The majority (88%) were breast (63%) or gynecologic (24%) cancer survivors. Patient age was evenly distributed with 8 age < 46, 11 age 46-59, and 7 age > = 60. 23 (56%) patients had stage < 3 at diagnosis. 21 (51%) had been cancer-free for five years + and 4 were referred by their oncologist to help with patient co-management during cancer treatment. Of the 8 breast cancer patients < 46 years old, 6 had a genetic mutation and 7 were interested in fertility. 15/26 breast cancer patients are currently on endocrine therapy. Interviewed patients expressed appreciation for receiving whole-person care and knowing there is bidirectional communication between clinicians. Conclusions: Cancer survivors are open to and interested in a survivorship visit based in a primary care clinic; this includes both patients who have been cancer-free > 5 years as well as those recently treated with curative intent. Greater efforts are needed to train primary care physicians to deliver survivorship visits that are customized to meet the needs of cancer survivors.

scholarly journals Survivorship Care Focus Group Discussions for Breast Cancer Survivors and Primary Care Clinicians

2021 ◽  
pp. 1-4
Author(s):  
Hillary Klonoff-Cohen ◽  
Hillary Klonoff-Cohen ◽  
Mounika Polavarapu
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Focus Group ◽  
Cancer Survivors ◽  
Nurse Practitioners ◽  
Late Effects ◽  
Primary Care Physicians ◽  
Breast Cancer Survivors ◽  
Survivorship Care ◽  
Psychological Consequences

Purpose: This is the first pilot study to examine survivors’ experiences and primary care physicians and nurse practitioners’ knowledge and behaviour practices with respect to late effects (e.g., fatigue, chemobrain, lymphodema, cardiac problems, reproductive, infertility and sexual health issues, bone problems, and pain). Methods: Two separate focus groups consisting of 5 breast cancer survivors and 5 primary care physicians and nurse practitioners recruited from a local hospital in Central Illinois answered predetermined questions about cancer survivorship care. We intentionally limited the sample in order to conduct a detailed discussion (90 minutes) to gain every participant’s perspective. Results: Breast cancer survivors expressed a void in discussion and lack of knowledge among their primary care physicians regarding late effects as well as psychological consequences, referrals to support groups, and availability of resources (e.g., finances), thereby negatively affecting survivors’ quality of life. A primary care clinician (PCC) focus group revealed a service gap for mental health services for all patients, knowledge deficit about late effects, and lack of awareness of patient resources. Both cancer survivors and PCCs were extremely supportive about a shared care survivorship model between oncology and primary care. All focus group participants were unequivocally receptive about enhancing survivorship care throughout a cancer survivor’s lifetime. Conclusion: Complementing cancer survivorship care with primary care clinicians in the areas of late effects, in addition to psychological consequences, screening, and lifestyle habits will enhance a cancer survivor’s health-related quality of life.

scholarly journals Rheumatic polymyalgia: clinic, diagnosis, principles of therapy (to help the primary care physician)

2021 ◽  
pp. 164-169
Author(s):  
M. S. Svetlova
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Care Physician ◽  
Diagnostic Methods ◽  
Malignant Neoplasms ◽  
Adequate Treatment ◽  
Laboratory Activity

In recent decades, there has been an increase in the number of elderly people. Among the patients of the primary care physician, without a doubt, those who are over 60 years old predominate. A feature of the elderly is polymorbidity. Combined pathology, numerous complaints of patients make it difficult to diagnose diseases, require patience from the doctor, and, of course, knowledge. There are diseases that are peculiar only to the elderly, developing only after 50 years. These include rheumatic polymyalgia. This pathology is not frequent and, in this regard, is not very familiar to outpatient therapists. However, it is to them that elderly patients turn with complaints of pain and stiffness in the shoulder and/or pelvic girdle, in the neck, in the joints of the hands, fever, weight loss, sleep disorders, depression, general malaise (the main complaints of patients with rheumatic polymyalgia). The above-mentioned clinical manifestations, as well as the high laboratory activity inherent in this disease, make the doctor look for malignant neoplasms, infectious, systemic processes. This takes a long time, the diagnosis is delayed, the sufferings of the patient are prolonged. The article presents data on the prevalence, clinical features, methods of diagnosis of rheumatic polymyalgia and its differential diagnosis. The criteria of the disease, the principles of management of the patient at the outpatient stage  (step-by-step treatment with glucocorticoids, alternative approaches, prevention of side effects of therapy, which develop quite often) are also given. Awareness of primary care physicians about rheumatic polymyalgia, its manifestations and diagnostic methods will speed up the diagnosis, timely consultation of the patient with a rheumatologist, which will allow you to start adequate treatment, significantly improve the quality of life of an elderly patient, and prevent the destabilization of concomitant diseases.

Integrating the primary care physician into cancer follow-up.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 102-102 ◽  
Author(s):  
Andrew L. Salner ◽  
Deborah Walker ◽  
Amanda Seltzer ◽  
SarahLena Panzer ◽  
Carrie Stricker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Physician ◽  
Care Physician ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Plans ◽  
Follow Up Care

102 Background: After a diagnosis of breast cancer, it can be difficult for patients to understand the role their primary care physician (PCP) should play in their follow up care. Methods: 65 women (mean age 60 years, SD = 10) with breast cancer (stage 0-III) were seen by a nurse practitioner for a 60-90 minute consultative survivorship visit and received a treatment summary and personalized survivorship care plan (SCP) utilizing Carevive Care Planning Systems software. The Carevive system incorporates patient-reported and clinical data to create tailored care plans with personalized recommendations for follow up care and supportive referrals, including direction to follow up with primary care for specific care and health maintenance activities. Approximately 6 weeks following their survivorship care visit, patients completed a survey assessing their use of and satisfaction with the SCP. Patients were advised that the SCP would be mailed to their referring oncologist and primary care physician. Results: Out of 65 sent, 35 surveys have been completed to date. Survivors were diagnosed approximately 10 months prior, and all were within 6 months following completion of treatment. All patients (100%) reported that they read, or planned to read, their survivorship care plan packet carefully. While all care plans included a recommendation to follow up with their PCP, only (71%) of survivors remembered receiving this recommendation. Of those who did, most (74%) had either seen or scheduled an appointment with their PCP. Patients who reported higher anxiety at the time of the survivorship visit were more likely to report that the follow up care plan helped them take action about seeing their PCP (p = .03). Conclusions: Coordination between primary and oncology care providers has previously been shown to improve the quality of care for cancer survivors. SCPs that emphasize the importance of and activities to be undertaken in primary care may help to improve this coordination. Continuation of this research will help to better understand how to integrate the primary care physician into cancer follow up care. Updated data will be shared at time of presentation.

Primary care physicians’ perspectives of the survivorship care for older breast cancer survivors: a pilot study

2019 ◽  
Vol 28 (2) ◽  
pp. 645-652 ◽  
Author(s):  
Jessica L. Krok-Schoen ◽  
Jennifer DeSalvo ◽  
Dori Klemanski ◽  
Christian Stephens ◽  
Anne M. Noonan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Pilot Study ◽  
Cancer Survivors ◽  
Primary Care Physicians ◽  
Breast Cancer Survivors ◽  
Survivorship Care

scholarly journals Hypercalcemia: An Ominous sign of Malignancy

2021 ◽  
pp. 1-2
Author(s):  
Zachary R Teibel ◽  
◽  
Mohammad Jurri ◽  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Serum Calcium ◽  
Primary Care Physicians ◽  
Elevated Serum ◽  
Clinical Manifestations ◽  
Metastatic Breast ◽  
Care Physician ◽  
Asymptomatic Patients ◽  
Malignant Breast

Hypercalcemia is a disorder commonly encountered by primary care physicians. The diagnosis often is made incidentally in asymptomatic patients Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. 90% of cases of hypercalcemia are due to primary hyperparathyroidism and malignancy. This article highlights the importance of proper work-up of elevated serum calcium levels and complications that can arise from failure to do so. This is a case report of a 63-year-old female who was found to have asymptomatic hypercalcemia of 10.5 mg/dl but was lost to follow up and presented four years later to her primary care physician with complaints of pain in the neck and weakness in bilateral shoulders, arms, wrists, and numbness of 4th and 5th digits. MRI revealed lytic lesions on the cervical and thoracic spine with compression deformity likely due to metastatic breast cancer. Lab reports revealed a serum calcium level of 12.1mg/dl and the patient’s chart (mammogram/ breast US) confirmed malignant breast cancer.

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