scholarly journals Use of physician services during the survivorship phase: a multi-province study of women diagnosed with breast cancer

2017 ◽  
Vol 24 (2) ◽  
pp. 81 ◽  
Author(s):  
C. Kendell ◽  
K.M. Decker ◽  
P.A. Groome ◽  
M.L. McBride ◽  
L. Jiang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
British Columbia ◽  
Nova Scotia ◽  
Cancer Survivors ◽  
Primary Care Providers ◽  
Care Providers ◽  
Follow Up Care ◽  
The Mean

Introduction Oncologists have traditionally been responsible for providing routine follow-up care for cancer survivors; in recent years, however, primary care providers (pcps) are taking a greater role in care during the follow-up period. In the present study, we used a longitudinal multi-province retrospective cohort study to examine how primary care and specialist care intersect in the delivery of breast cancer follow-up care.Methods Various databases (registry, clinical, and administrative) were linked in each of four provinces: British Columbia, Manitoba, Ontario, and Nova Scotia. Population-based cohorts of breast cancer survivors were identified in each province. Physician visits were identified using billings or claims data and were classified as visits to primary care (total, breast cancer–specific, and other), oncology (medical oncology, radiation oncology, and surgery), and other specialties. The mean numbers of visits by physician type and specialty, or by combinations thereof, were examined. The mean numbers of visits for each follow-up year were also examined by physician type.Results The results showed that many women (>64%) in each province received care from both primary care and oncology providers during the follow-up period. The mean number of breast cancer–specific visits to primary care and visits to oncology declined with each follow-up year. Interprovincial variations were observed, with greater surgeon follow-up in Nova Scotia and greater primary care follow-up in British Columbia. Provincial differences could reflect variations in policies and recommendations, relevant initiatives, and resources or infrastructure to support pcp-led follow-up care.Conclusions Optimizing the role of pcps in breast cancer follow-up care might require strategies to change attitudes about pcp-led follow-up and to better support pcps in providing survivorship care.

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

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.

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

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.

Evaluation of coordination of cancer care between designated cancer hospitals and primary care providers: Results from a nationwide survey in Japan.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 84-84
Author(s):  
Taro Tomizuka ◽  
Tomone Watanabe ◽  
Satoru Kamitani ◽  
Takahiro Higashi
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Care Coordination ◽  
Cancer Care ◽  
Critical Path ◽  
Primary Care Providers ◽  
Care Providers ◽  
Follow Up Care ◽  
Cancer Specialist

84 Background: To improve coordination of cancer care between cancer specialist hospitals and primary care providers (PCPs), the Japanese government accredited cancer specialist hospitals, so called “designated cancer care hospitals (DCCHs)” and introduced “Cancer care coordination instruction fee” which PCPs can receive if they share a cancer critical path (Japanese version of Survivorship Care Plans) of each cancer patient with DCCHs. We sought to assess the current status of coordination of cancer care in Japan and communication between DCCHs and PCPs from PCPs’ point of view. Methods: A cross-sectional mail survey was administered to randomly selected clinic-based PCPs (4,000 clinics) from a nation-wide database of medical institutions authorized by Ministry of Health, Labour and Welfare Japan to treat patients with health insurance (87,869 clinics). The survey evaluated how much PCPs provided cancer follow-up care and how well DCCHs coordinated care and communicated with PCPs in cancer survivorship. Results: 1,873 PCPs returned the questionnaire (response rate: 46.8%). 1,223 (65.3%) answered to provide cancer follow-up care in outpatient setting. Most of the PCPs which provided cancer follow-up care evaluated the care coordination and support by DCCHs were satisfactory (946, 77.4%) but the degree of good evaluation varied by region (highest: 91.3%, lowest: 45.8%). In regression analysis, provision of palliative care by PCPs (OR 1.52 95%CI 1.05-2.17) and use of cancer critical path (OR 2.10 95%CI 1.63-2.71) were significantly correlated with better evaluation of communication and care coordination. Conclusions: DCCHs communicated well with PCPs and PCPs were satisfied with the communication and care coordination by DCCHs. Provision of palliative care by PCPs and use of cancer critical path are likely to lead good care coordination in cancer care.

scholarly journals Preferences for Physician Roles in Follow-up Care During Survivorship: Do Patients, Primary Care Providers, and Oncologists Agree?

2018 ◽  
Vol 34 (2) ◽  
pp. 184-186 ◽  
Author(s):  
Archana Radhakrishnan ◽  
M. Chandler McLeod ◽  
Ann S. Hamilton ◽  
Kevin C. Ward ◽  
Steven J. Katz ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Follow Up Care ◽  
Physician Roles

Guideline-concordant surveillance and follow-up care among low-income patients with breast cancer: The role of primary care medical homes.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 171-171
Author(s):  
Stephanie B. Wheeler ◽  
Racquel Elizabeth Kohler ◽  
Ravi K. Goyal ◽  
Kristen Hassmiller Lich ◽  
Alexis Moore ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Low Income ◽  
Breast Cancer Survivors ◽  
Breast Cancer Survivorship ◽  
Medical Homes ◽  
Follow Up Care

171 Background: Community Care of North Carolina (CCNC) initiated an innovative medical home (MH) program in the 1990s to improve primary care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular outcomes, but has not been evaluated in the context of cancer care. We sought to determine whether MH enrollment was associated with guideline-concordant surveillance and follow-up care among breast cancer survivors. Methods: Using state cancer registry records matched to Medicaid claims, we identified women ages 18-64 diagnosed with stage 0, I, or II breast cancer from 2003-2007 and tracked their CCNC enrollment. Using published American Society for Clinical Oncology breast cancer survivorship guidelines to define our outcomes, we employed multivariate logistic regressions to examine correlates of receipt of surveillance mammogram and at least two physical exams within 15 months post-diagnosis. Results: In total, 840 women were included in our sample. Approximately half were enrolled in a CCNC MH during the study period, 38% were enrolled for more than 7 months post-diagnosis. Enrollment in a MH for at least 7 months post-diagnosis was strongly associated with receiving guideline-recommended surveillance mammogram (p<0.01) and at least 2 physical exams (p<0.01) within 15 months post-diagnosis. Conclusions: Results suggest that MH enrollment is associated with higher quality breast cancer survivorship care among women insured by Medicaid. Given the growing population of cancer survivors and increased emphasis on primary care MH, more research is needed to explore how medical homes can enhance and ensure the provision of guideline-recommended care during cancer survivorship.

The use of electronic health record systems to create treatment summaries and survivorship care plans.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 56-56
Author(s):  
Katherine Ramsey Gilmore ◽  
David K Choi ◽  
Patricia Chapman ◽  
Paula A. Lewis-Patterson ◽  
Guadalupe R. Palos ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Treatment Summaries ◽  
Care Plans ◽  
Patient Level ◽  
Follow Up Care ◽  
Electronic Health

56 Background: The Commission on Cancer’s recent mandate stated that accredited programs issue treatment summaries (TSs) with survivorship follow-up care plans (SCPs). ASCO’s model of survivorship care also supports the use of these documents. One of the primary purposes of the documents is to enhance coordination and communication between the oncology team and primary care providers. Here we describe the experience of a survivorship program in using electronic health records (EHR) to develop TSs and SCPs. Methods: An interdisciplinary team at an academic cancer center was appointed to develop clinical tools to facilitate the creation and dissemination of TSs and SCPs. Enhancements were made to an institutional off-the-shelf EHR system that automatically populated available treatment information to the TS. This system used SmartLinks to pull data from the primary source of entry (e.g. surgical history, chemotherapy administered, and cancer stage). Clinicians edited and added pertinent information not automatically generated using one of the 19 disease-specific templates that provided lists of common treatments for various cancers. Electronic routing functions existed to share TSs with external providers through the medical records department. Results: From March-Sept, 2016, 766 SCP were completed by 50 providers in 14 clinics. Reports were created in the EHR to track SCPs and TS metrics. Data was reported from the TS on both a patient level and aggregate level by provider and clinic. Patient level data allowed providers to track incomplete TSs and edit them directly from the report. Of the TSs completed, 528 (69%) have been shared with patients and 261 (34%) have been shared with their community-based providers. Conclusions: EHRs provide a mechanism to successfully create and share TSs and SCPs among team members and primary care providers. They promote patient-provider education and communication about follow-up care. Research is needed to determine how they enhance coordination and ultimately outcomes for long-term survivors.

Primary care providers as partners in long-term follow-up of pediatric cancer survivors

2012 ◽  
Vol 6 (3) ◽  
pp. 270-277 ◽  
Author(s):  
Lillian R. Meacham ◽  
Paula J. Edwards ◽  
Brooke O. Cherven ◽  
Michael Palgon ◽  
Sofia Espinoza ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Pediatric Cancer ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pediatric Cancer Survivors ◽  
Long Term Follow Up
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