Predicting Primary Care Use Among Patients 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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Actual Versus Projected Cost Avoidance for Clinical Pharmacy Specialist -Initiated Medication Conversions in a Primary Care Setting in an Integrated Health System

Journal of Managed Care Pharmacy ◽

10.18553/jmcp.2008.14.2.155 ◽

2008 ◽

Vol 14 (2) ◽

pp. 155-163 ◽

Cited By ~ 1

Author(s):

Beverly A. Kroner ◽

Sarah J. Billups ◽

Kathleen M. Garrison ◽

Alfred E. Lyman ◽

Thomas Delate

Keyword(s):

Primary Care ◽

Health System ◽

Clinical Pharmacy ◽

Care Setting ◽

Primary Care Setting ◽

Cost Avoidance ◽

Integrated Health

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Implementing Primary Care Mediated Population Genetic Screening within an Integrated Health System

10.1101/2020.07.16.20140228 ◽

2020 ◽

Author(s):

Sean P David ◽

Henry M Dunnenberger ◽

Raabiah Ali ◽

Adam Matsil ◽

Amy A Lemke ◽

...

Keyword(s):

Primary Care ◽

Health System ◽

Genetic Screening ◽

Screening Program ◽

Median Number ◽

Large Impact ◽

Preventative Care ◽

Number Of Patients ◽

Integrated Health ◽

The Impact

AbstractIntroductionGenetic screenings can have a large impact on enabling personalized preventative care. However, this can be limited by the primary use of medical history-based screenings in determining care. The purpose of this study was to understand the impact of DNA10K, a population-based genetic screening program mediated by primary care physicians (PCPs) within an integrated health system to emphasize its contribution to preventative healthcare.MethodsConstruction of the patient experience as part of DNA10K shaped the context for PCP engagement within the program. A cross-sectional analysis of patient consents, orders, tests, and results of nearly 10,000 patients within the primary care specialties of family medicine, internal medicine or obstetrics/gynecology between April 1, 2019 and January 22, 2020 was conducted.ResultsAcross all specialties, a median number of 7.5 cancer and cardiovascular disease variants per PCP was found. The average age of the study population was 49.6 years. Over 8% of these patients had at least one actionable genetic risk variant and almost 2% of patients had at least one CDC Tier 1 variant. The median number of patients per PCP with either hereditary breast and ovarian cancer, Lynch Syndrome, or Familial Hypercholesterolemia was 1 (Interquartile Range 0-2).DiscussionThe analysis of test results and the engagement of an integrated healthcare system in the implementation of a genetic screening program suggests that it can have a large impact on population health outcomes and minimal referral burden to PCPs if identified risks can lead to preventative care.

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