Importance of primary care for underserved cancer patients with multiple chronic conditions

• Published in: Journal of cancer survivorship Vol. 17; no. 5; pp. 1276 - 1285
• Main Authors: Jetelina, Katelyn K., Lee, Simon Craddock, Booker-Nubie, Quiera S., Obinwa, Udoka C., Zhu, Hong, Miller, Michael E., Sadeghi, Navid, Dickerson, Umber, Balasubramanian, Bijal A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2023; Springer Nature B.V
• Subjects: Adult; Cancer; Cancer Survivors; Cancer therapies; Chronic conditions; Chronic Disease; Chronic illnesses; Colorectal cancer; Colorectal carcinoma; Comorbidity; Electronic health records; Electronic medical records; Emergency medical care; Emergency medical services; Health care; Health Informatics; Health Promotion and Disease Prevention; Health services utilization; Humans; Medicine; Medicine & Public Health; Metastases; Multiple Chronic Conditions; Neoplasms - therapy; Oncology; Patient Acceptance of Health Care; Patients; Primary care; Primary Care Medicine; Primary Health Care; Public Health; Quality of Life Research; Regression analysis; Retrospective Studies; Survival; System effectiveness; Healthcare utilization; Primary care; Safety-net; Complex cancer
• ISSN: 1932-2259; 1932-2267; 1932-2267
• DOI: 10.1007/s11764-021-01159-8

Purpose 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. Methods 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. Results 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. Conclusion 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. Implications for Cancer Survivors Maintaining regular connections with primary care providers during active cancer treatment should be promoted.