Significant decline in cancer diagnostic testing in U.S. CMS population during the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6536-6536
Author(s):  
Dave Smart ◽  
Peter Riccelli ◽  
Keith Kerr ◽  
Jordan Clark ◽  
Susanne Munksted Fosvig ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Delayed Diagnosis ◽  
Cancer Control ◽  
Unintended Consequences ◽  
Initial Diagnosis ◽  
Test Volume ◽  
The Us

6536 Background: The COVID-19 pandemic has caused >400,000 infection related deaths in the US to January 2021. Actions taken to limit COVID-19 infection and mortality could potentially lead to unintended consequences, precipitating excess mortality due to other causes. One such cause is delayed cancer diagnosis. Significant decreases in presentation for cancer diagnosis at the primary care level have been noted in the UK. This study aimed to look for evidence of a similar effect in the US. Methods: CMS claims data from JAN18-JUN20 associated with primary diagnosis across 11 cancers (bladder, breast, cervical, colorectal, endometrial, lung, ovarian, pancreatic, prostate, sarcoma and thyroid) were analyzed for use of surgical pathology (SP), a procedure associated with initial diagnosis, and immunohistochemistry (IHC). Test volumes varied widely by test and cancer so were normalized to enable comparison across indications. This was done by dividing the month-on-month difference for the period JAN19-JUN19 vs JAN20-JUN20 by the median monthly test volume for the period JAN18-DEC19 (“pre-COVID period”). Extent and duration of declines in test rates and number of missing patients as the sum of these declines were then determined. The ratio of IHC to SP testing was taken to determine any decline in likely post-initial diagnosis testing. Results: There were significant (>10%) declines in test volumes for SP for all 11 cancers at some time in Q1-Q2 2020. Table. Extent, duration and return to pre-COVID levels for SP testing across 11 cancers Median extent and duration of the decline was 56% (range 41.1%-80.4%) and 2 months (range 1- >4). This equates to 32,192 missing diagnoses across all cancers. SP test volumes for all cancers except lung and breast had returned to around pre-COVID levels by JUN20. There was no significant (>10%) increase in normalized SP test volume after the COVID dip for any cancer. While SP showed decreased test volumes across all cancers at some point during the first half of 2020, test volume ratios of IHC to SP showed increases for most cancers in the same time period. Conclusions: These data highlight that the decline in patients presenting to their primary care physicians with suspicion of cancer for diagnostic investigation was linked to COVID-19 prevention strategies. No evidence for increased, “catch up” testing to address presentational/diagnostic backlog was observed. Thus, it is predicted that these patients may subsequently present with a more advanced cancer. Potential excess morbidity, mortality and cost associated with absent or delayed diagnosis should be factored into cancer control programs going forward.[Table: see text]

Cancer control knowledge and priorities among primary care physicians

1993 ◽  
Vol 8 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Ross Brownson ◽  
James Davis ◽  
Sherri Simms ◽  
Thomas Kern ◽  
Robert Harmon
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Cancer Control ◽  
Control Knowledge

scholarly journals Practices and perspectives of primary care physicians in Japan and the United States about diagnosing dementia: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Abe ◽  
S. Tsunawaki ◽  
M. Dejonckheere ◽  
C. T. Cigolle ◽  
K. Phillips ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Intervention ◽  
Advance Directives ◽  
Primary Care Physicians ◽  
Long Term Care ◽  
Term Care ◽  
Care Services ◽  
The Us ◽  
Diagnosis Of Dementia

Abstract Background While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown. Methods Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians. Results Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers. Conclusions Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.

scholarly journals Screening Colonoscopy in the US: Attitudes and Practices of Primary Care Physicians

2012 ◽  
Vol 27 (9) ◽  
pp. 1150-1158 ◽  
Author(s):  
Jane Zapka ◽  
Carrie N. Klabunde ◽  
Stephen Taplin ◽  
Gigi Yuan ◽  
David Ransohoff ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Screening Colonoscopy ◽  
Attitudes And Practices ◽  
The Us

Barriers To Diagnosis In Myeloproliferative Neoplasms

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5248-5248
Author(s):  
Raymond H L Yip ◽  
Lynda M Foltz
Keyword(s):  
Primary Care ◽  
Median Time ◽  
Primary Care Physicians ◽  
Myeloproliferative Neoplasms ◽  
Diagnostic Testing ◽  
Primary Care Providers ◽  
Care Providers ◽  
Average Delay ◽  
Delay In Diagnosis ◽  
Hemorrhagic Complications

Abstract Background Timely diagnosis of patients (pts) with polycythemia vera (PV) and essential thrombocythemia (ET) is important given the risks of thrombotic and hemorrhagic complications, disease progression and associated symptoms.  Pts often present initially to primary care physicians, who may have limited previous experience with PV/ET given the low prevalence.  Little is known about the timeliness of referral or diagnostic testing after identification of abnormal blood test results or if delays in diagnosis affect patient outcomes. Objectives To determine the time from initial lab abnormality to referral, diagnosis and treatment of pts with PV and ET. Methods Pts at a single Canadian academic institution newly diagnosed with PV or ET from Jan 2010 to May 2013 were identified.  Retrospective data was collected including demographics, lab values, diagnostic testing and treatments. Results Demographics: 26 pts with PV and 34 with ET were identified.  Median age was 67.5 (44-89) y for PV and 66.5 (34-92) y for ET. Delay in Referral and Diagnosis: 98% of pts were referred directly to a hematologist by their primary care physician.  69% of PV pts were referred within 30 days and 92% within 90 days of initial lab abnormality.  Median time from referral to diagnosis was 98 (0-221) days.  41% of ET pts were referred within 30 days and 56% within 90 days of initial lab abnormality.  Median time from referral to diagnosis was 121 (8-638) days.  PV pts were referred sooner, median 20 (0-187) days, than ET pts, median 67 (0-3743) days (p=0.01).  The median delay from referral until hematology assessment was 51 days for PV compared to 78 days for ET (p=0.08).  After assessment by the hematologist, it required a median of 35 days to make a diagnosis of PV and 25 days for a diagnosis of ET (p=0.31). Referrals by platelet (plt) count: There was a trend to earlier referral of ET pts with higher platelet (plt) counts.  15/20 (75%) ET pts with plt count >600 were referred within 90 days of initial lab abnormality whereas only 4/14 (29%) of pts with plt count 450-600 were referred within 90 days (p=0.056). Treatment of PV pts: 22/26 (85%) pts received phlebotomy at or after referral at the direction of a hematologist.  Average delay in referral (and phlebotomy initiation) for patients treated with phlebotomy was 32 days.  13/26 (50%) pts were initiated on treatment with hydroxyurea within 2 months of diagnosis.  Average delay in diagnosis (and hydroxyurea initiation) in this subgroup was 142 days.   11/26 (42%) pts were receiving ASA prior to the initial hematological consultation.  12/26 (46%) were initiated on ASA at or shortly after hematological consultation.  Average delay to hematology consultation (and ASA initiation) was 90 days in this subgroup. Treatment of ET pts: 8/34 (24%) pts were initiated on treatment with hydroxyurea within 2 months of diagnosis.  Average delay in diagnosis (and hydroxyurea initiation) in this subgroup was 790 days. 17/34 (50%) pts were receiving ASA prior to the initial hematological consultation.  15/34 (44%) were initiated on ASA at or shortly after hematological consultation.  Average delay to hematology consultation (and ASA initiation) was 355 days in this subgroup. No thrombotic or major hemorrhagic complications occurred in any PV/ET pts between the time of initial lab abnormality and diagnosis. Discussion This study demonstrates the marked variability in time from lab abnormality to referral and diagnosis for PV/ET pts.  Primary care providers were more likely to promptly refer PV pts than ET pts, and particularly tended to overlook referral and investigation of pts with modestly elevated plt counts of 450-600.  This is a concern, as risk of thrombosis in ET pts is independent of plt count.  Delays were also apparent in wait times for hematology appointments and subsequent diagnostic tests.   The delay in diagnosis led to a delay in initiation of therapy to reduce risk of thrombosis in both PV and ET pts.  Possible strategies to expedite diagnosis include targeted education of primary care physicians focusing on identification of lab features of PV/ET.  Directive comments on lab reports by community hematopathologists may also facilitate prompt referral and investigation. Disclosures: No relevant conflicts of interest to declare.

Is an online skin cancer toolkit an effective way to educate primary care physicians about skin cancer diagnosis and referral?

2015 ◽  
Vol 29 (11) ◽  
pp. 2152-2159 ◽  
Author(s):  
A. Gulati ◽  
C.A. Harwood ◽  
J. Rolph ◽  
E. Pottinger ◽  
J.M. Mcgregor ◽  
...  
Keyword(s):  
Primary Care ◽  
Skin Cancer ◽  
Cancer Diagnosis ◽  
Primary Care Physicians

scholarly journals Work stress of primary care physicians in the US, UK and German health care systems

2010 ◽  
Vol 71 (2) ◽  
pp. 298-304 ◽  
Author(s):  
Johannes Siegrist ◽  
Rebecca Shackelton ◽  
Carol Link ◽  
Lisa Marceau ◽  
Olaf von dem Knesebeck ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Work Stress ◽  
Primary Care Physicians ◽  
Health Care Systems ◽  
German Health ◽  
The Us ◽  
Care Systems

scholarly journals Patients’ Coping Behaviors to Unavailability of Essential Medicines in Primary Care in Developed Urban China

2020 ◽  
Author(s):  
Dan Wu ◽  
Tai Pong Lam ◽  
Kwok Fai Lam ◽  
Kai Sing Sun ◽  
Xu Dong Zhou
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Patient Flow ◽  
Unintended Consequences ◽  
Essential Medicines ◽  
Service Users ◽  
Unintended Effects ◽  
Coping Behaviors ◽  
Primary Care System ◽  
Care System

Background: China rolled out the national essential medicines policy (NEMP) in primary care in 2009 and led to some unintended consequences including unavailability of essential medicines. This study examined patients’ coping behaviors to these unintended consequences of NEMP as well as the potential impact on primary care system development in Hangzhou, a developed city of China. Methods: We conducted qualitative interviews and surveys with service users, primary care physicians (PCPs), and specialists in tertiary hospitals. Qualitative findings informed the design of the survey questionnaires. Main outcomes included patients’ coping behaviors after the NEMP implementation, as well as providers’ perceptions of NEMP’s impact on primary care development. Thematic analysis of the qualitative data and descriptive analysis of the survey data were conducted. Results: Unintended effects of NEMP included frequent unavailability of certain essential drugs, leading to patient flow from primary care to hospital outpatient clinics for drug refills, difficulties in the provision of continuing care in primary care, as well as compromised patient trust in PCPs. In total, 1248 service users completed the questionnaires. A total of 132 (10.6%) were aged 60 years or above. Among 153 (57.7%) of the 265 who had some chronic condition(s) and needed long-term medication treatment, 60.1% went to hospitals for refills. Four-hundred sixty PCPs and 651 specialists were recruited. Among 404 PCPs who were aware of the NEMP policy implementation in their facility, 169 (41.8%) reported that there was often a shortage of drugs at their facilities and 44 (10.9%) reported always. Moreover, 68.6% of these PCPs thought that the NEMP could not meet their patients’ needs. Further, 44.2% (220/498) of specialists who were aware of the NEMP policy in primary care reported that they often heard patients complaining about the policy. In total, 53.1% of PCPs and 42.4% of specialists disagreed that NEMP helped direct patient flow to community-based care. Conclusion: NEMP’s unintended effects undermined patients’ utilization of primary care in a developed city in China and led to unnecessary hospital visits. Countermeasures are needed to mitigate the negative impacts of NEMP on the primary care system.

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