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      Disconnect between primary care and cancer follow-up care: An exploratory study from Odisha, India

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          Objective: There has been a steady increase in the demand for cancer follow-up care in India. Compared with Western countries, there is little evidence on the capacity of the Indian primary care workforce to accommodate such tasks. We explored the perceptions of oncologists, general practitioners, and patients with regard to the involvement of primary care in cancer follow-up care.

          Methods: We undertook semistructured focus-group discussions with eight oncologists, nine general practitioners, and 17 cancer patients to gain an understanding of their perceived roles and responsibilities with regard to primary care in delivering follow-up care and the potential concerns. Data from the focus groups were transcribed verbatim, translated, and analyzed with use of a thematic approach.

          Results: Most general practitioners felt that their job is to see ‘normal’ patients, and cancer patients were exceptions to routine care. Oncologists were apprehensive with regard to the competence of general practitioners and patient trust. Patients consult oncologists for cancer follow-up care as they perceive it to be very specialized. Patients expressed difficulty in accessing follow-up care and want specialized oncological care by trained personnel in their vicinity.

          Conclusion: Despite the growing number of cancer survivors, we found a disconnect between primary care and cancer follow-up care.

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          Most cited references 66

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          Chronic diseases and injuries in India.

          Chronic diseases (eg, cardiovascular diseases, mental health disorders, diabetes, and cancer) and injuries are the leading causes of death and disability in India, and we project pronounced increases in their contribution to the burden of disease during the next 25 years. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases and injuries through private and public sectors; improved public health and primary health-care systems are essential for the implementation of cost-effective interventions. We strongly advocate the need to strengthen social and policy frameworks to enable the implementation of interventions such as taxation on bidis (small hand-rolled cigarettes), smokeless tobacco, and locally brewed alcohols. We also advocate the integration of national programmes for various chronic diseases and injuries with one another and with national health agendas. India has already passed the early stages of a chronic disease and injury epidemic; in view of the implications for future disease burden and the demographic transition that is in progress in India, the rate at which effective prevention and control is implemented should be substantially increased. The emerging agenda of chronic diseases and injuries should be a political priority and central to national consciousness, if universal health care is to be achieved. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Under use of necessary care among cancer survivors.

             B. Neville,  C Earle (2004)
            Comorbid conditions are the major threat to life for many cancer survivors, yet little is known about the quality of the noncancer-related health care they receive. The authors analyzed the Medicare claims of 14,884 Medicare-eligible, 5-year colorectal carcinoma survivors who were diagnosed initially while they lived in a region monitored by the Surveillance, Epidemiology, and End Results (SEER) Program and compared them with matched controls who had no history of cancer drawn from the Medicare 5% sample. In both univariable and multivariable analyses, cancer survivorship was associated with an increased likelihood of not receiving recommended care across a broad range of chronic medical conditions (odds ratio, 1.19, 95% confidence interval, 1.12-1.27). For example, colorectal carcinoma survivors were less likely than controls to receive appropriate follow-up for heart failure, necessary diabetic care, or recommended preventive services. Having both primary care physicians and oncologists involved in follow-up appeared to ameliorate this effect significantly. African-American, poor, and elderly patients were less likely to receive necessary care in both groups. Whether it was due to patient factors, physician factors, or both, cancer survivors appear to be a vulnerable patient population, because their cancer diagnosis may shift attention away from important noncancer problems and providers. In addition, there may be lack of clarity around the relative roles primary care and specialist physicians will play in a survivor's care. Special attention and education are needed to ensure that survivors receive optimal medical services.
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              The logic of care: Health and the problem of patient choice


                Author and article information

                Family Medicine and Community Health
                Compuscript (Ireland )
                September 2015
                October 2015
                : 3
                : 3
                : 9-17
                1Indian Institute of Public Health Bhubaneswar, Public Health Foundation of India, 2nd and 3rd Floor, JSS Software Technology Park, E1/1, Infocity Road, Patia, Bhubaneswar 751024, Odisha, India
                2All India Institute of Medical Sciences, Sijua, Bhubaneswar 751019, Odisha, India
                3Ex-Director, Regional Cancer Center, Cuttack Odisha, India
                4Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Medical Quad Teviot Place, Edinburgh EH8 9DX, UK
                Author notes
                CORRESPONDING AUTHOR: Sanghamitra Pati, Additional Professor, Indian Institute of Public Health Bhubaneswar, Public Health Foundation of India, 2nd and 3rd Floor, JSS Software Technology Park, E1/1, Infocity Road, Patia, Bhubaneswar 751024, Odisha, India, E-mail: sanghamitra.pati@ 123456iiphb.org , drsanghamitra12@ 123456gmail.com
                Copyright © 2015 Sanghamitra Pati, Sukdev Nayak, David Weller/CC-BY-4.0

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                Self URI (journal page): http://fmch-journal.org/
                Original Research


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