Importance of primary care for underserved cancer patients with multiple chronic conditions.
Importance of primary care for underserved cancer patients with multiple chronic conditions.
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DOI：
10.1007/s11764-021-01159-8
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发表时间：
2023-10
期刊：
影响因子：
--
通讯作者：
Balasubramanian BA
中科院分区：
文献类型：
--
作者：
Jetelina KK;Lee SC;Booker-Nubie QS;Obinwa UC;Zhu H;Miller ME;Sadeghi N;Dickerson U;Balasubramanian BA
了解在从癌症治疗过渡到治疗后生存期的过程中，既存疾病对医疗保健利用的影响。使用电子健康记录数据，我们构建了一个2010年1月1日至2016年12月31日期间在综合县卫生系统中就诊的患者队列。在此期间，631例诊断为非转移性乳腺癌或结直肠癌的成年患者（病例）在性别和Charlson合并症指数上与至少有两种慢性疾病且在研究期间至少有一次健康系统访视的非癌症患者（对照组）1：1匹配。条件固定效应Poisson回归模型比较了癌症和非癌症患者的初级保健和急诊科（艾德）就诊次数以及完成[与未就诊或错过]预约的次数。癌症患者的访视次数显著低于非癌症患者（N = 46，965 vs. 85，038）。与非癌症患者相比，癌症患者不太可能接受初级保健（IRR = 0.25; 95% CI：0.24，0.27）和艾德访视（IRR = 0.57; 95% CI：0.50，0.64），但更可能完成预定的预约（AOR = 4.83; 95% CI：4.32，5.39）。在初级保健中以较高比率就诊的癌症患者比在初级保健中以较低比率就诊的癌症患者更有可能去艾德就诊（IRR = 2.06; 95% CI：1.52，2.80）。卫生系统需要找到创新的、有效的解决方案，以提高患有慢性病的癌症患者对初级保健的利用率，确保对慢性病和癌症的最佳管理。在积极的癌症治疗期间，应促进与初级保健提供者的定期联系。
To understand the impact of pre-existing conditions on healthcare utilization among under- and uninsured patients in the transition from cancer treatment to post-treatment survivorship. Using electronic health record data, we constructed a cohort of patients seen in an integrated county health system between 1/1/2010 and 12/31/2016. Six hundred thirty-one adult patients diagnosed with non-metastatic breast or colorectal cancer during this period (cases) were matched 1:1 on sex and Charlson comorbidity index to non-cancer patients who had at least two chronic conditions and with at least one visit to the health system during the study period (controls). Conditional fixed effects Poisson regression models compared number of primary care and emergency department (ED) visits and completed [vs. no show or missed] appointments between cancer and non-cancer patients. Cancer patients had significantly lower number of visits compared with non-cancer patients (N = 46,965 vs. 85,038). Cancer patients were less likely to have primary care (IRR = 0.25; 95% CI: 0.24, 0.27) and ED visits (IRR = 0.57; 95% CI: 0.50, 0.64) but more likely to complete a scheduled appointment (AOR = 4.83; 95% CI: 4.32, 5.39) compared with non-cancer patients. Cancer patients seen in primary care at a higher rate were more likely to visit the ED (IRR = 2.06; 95% CI: 1.52, 2.80) than those seen in primary care at a lower rate. Health systems need to find innovative, effective solutions to increase primary care utilization among cancer patients with chronic care conditions to ensure optimal management of both chronic conditions and cancer. Maintaining regular connections with primary care providers during active cancer treatment should be promoted.
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影响因子：
3.6
作者：
Kaplan-Lewis, Emma;Percac-Lima, Sanja
通讯作者：
Percac-Lima, Sanja
DOI：
10.1007/978-3-319-16366-6_11
发表时间：
2015-01-01
期刊：
IMPROVING OUTCOMES FOR BREAST CANCER SURVIVORS: PERSPECTIVES ON RESEARCH CHALLENGES AND OPPORTUNITIES
影响因子：
--
作者：
Hong, Chi-Chen;Ambrosone, Christine B.;Goodwin, Pamela J.
通讯作者：
Goodwin, Pamela J.
影响因子：
13.8
作者：
Balasubramanian BA;Higashi RT;Rodriguez SA;Sadeghi N;Santini NO;Lee SC
通讯作者：
Lee SC
影响因子：
--
作者：
Lee, Simon J. Craddock;Clark, Mark A.;Balasubramanian, Bijal A.
通讯作者：
Balasubramanian, Bijal A.
影响因子：
4.4
作者：
Nutting, Paul A;Goodwin, Meredith A;Stange, Kurt C
通讯作者：
Stange, Kurt C