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      Exploring why patients with cancer consult GPs: a 1-year data extraction

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          Abstract

          Background

          Survival rates of patients with cancer are increasing owing to improvements in diagnostics and therapies. The traditional hospital-based follow-up model faces challenges because of the consequent increasing workload, and it has been suggested that selected patients with cancer could be followed up by GPs.

          The hypothesis of the study was that, regardless of the hospital-based follow-up care, GPs see their patients with cancer both for cancer-related problems as well as for other reasons. Thus, a formalised follow-up by GPs would not mean too large a change in GPs’ workloads.

          Aim

          To explore to what extent patients with cancer consult their GPs, and for what reasons.

          Design & setting

          A 1-year explorative study was undertaken, based on data from 91 Norwegian GPs from 2016–2017.

          Method

          The data were electronically extracted from GPs' electronic medical records (EMR).

          Results

          Data were collected from 91 GPs. There were 11 074 consultations in total, generated by 1932 patients with cancer. The mean consultation rate was higher among the patients with cancer compared with Norwegian patients in general. In one-third of the consultations, cancer was the main diagnosis. Apart from cancer, cardiovascular and musculoskeletal diagnoses were common. Patients with cancer who had multiple diagnoses or psychological diagnoses did not consult their GP significantly more often than patients with cancer without such comorbidity.

          Conclusion

          This study confirms that patients with cancer consult their GP more often than other patients, both for cancer-related reasons and for various comorbidities. A formalised follow-up by GPs would probably be feasible, and GPs should prepare for this responsibility.

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          Most cited references19

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          The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: A systematic review.

          It is unclear whether breast cancer survivors have a higher risk of long-term symptoms of depression or anxiety. The aim of this study was to systematically review the evidence about long-term symptoms of depression and anxiety in breast cancer survivors.
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            Primary care physicians' views of routine follow-up care of cancer survivors.

            Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown. A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined. A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 +/- 2.3 years had elapsed for prostate cancer, 2.6 +/- 2.6 years for colorectal cancer, 2.8 +/- 2.5 years for breast cancer, and 3.2 +/- 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence. With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.
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              Use of general practice, diagnostic investigations and hospital services before and after cancer diagnosis - a population-based nationwide registry study of 127,000 incident adult cancer patients

              Background Knowledge of patterns in cancer patients’ health care utilisation around the time of diagnosis may guide health care resource allocation and provide important insights into this groups’ demand for health care services. The health care need of patients with comorbid conditions far exceeds the oncology capacity and it is therefore important to elucidate the role of both primary and secondary care. The aim of this paper is to describe the use of health care services amongst incident cancer patients in Denmark one year before and one year after cancer diagnosis. Methods The present study is a national population-based case–control (1:10) registry study. All incident cancer patients (n = 127,210) diagnosed between 2001 and 2006 aged 40 years or older were identified in the Danish Cancer Registry. Data from national health registries were provided for all cancer patients and for 1,272,100 controls. Monthly consultation frequencies, monthly proportions of persons receiving health services and three-month incidence rate ratios for one year before and one year after the cancer diagnosis were calculated. Data were analysed separately for women and men. Results Three months before their diagnosis, cancer patients had twice as many general practitioner (GP) consultations, ten to eleven times more diagnostic investigations and five times more hospital contacts than the reference population. The demand for GP services peaked one month before diagnosis, the demand for diagnostic investigations one month after diagnosis and the number of hospital contacts three months after diagnosis. The proportion of cancer patients receiving each of these three types of health services remained more than 10% above that of the reference population from two months before diagnosis until the end of the study period. Conclusions Cancer patients’ health service utilisation rose dramatically three months before their diagnosis. This increase applied to all services in general throughout the first year after diagnosis and to the patients’ use of hospital contacts in particular. Cancer patients’ heightened demand for GP services one year after their diagnosis highlights the importance of close coordination and communication between the primary and the secondary healthcare sector.
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                Author and article information

                Journal
                BJGP Open
                BJGP Open
                bjgpoa
                bjgpoa
                BJGP Open
                Royal College of General Practitioners
                2398-3795
                December 2019
                02 October 2019
                02 October 2019
                : 3
                : 4
                : bjgpopen19X101663
                Affiliations
                [1 ] deptDoctoral Research Fellow, General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society , University of Oslo , Oslo, Norway
                [2 ] deptDoctoral Research Fellow, Department of Obstetrics and Gynecology , Sørlandet Hospital Kristiansand , Kristiansand, Norway
                [3 ] deptConsultant, Department of Obstetrics and Gynecology , Sørlandet Hospital Kristiansand , Kristiansand, Norway
                [4 ] deptAssociate Professor, General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society , University of Oslo , Oslo, Norway
                [5 ] deptProfessor, General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society , University of Oslo , Oslo, Norway
                Author notes
                *For correspondence: Heidi Lidal Fidjeland, h.l.fidjeland@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-3327-7148
                Article
                01663
                10.3399/bjgpopen19X101663
                6995854
                31581120
                f3332f35-2dce-4f22-a5d8-d9f058560535
                Copyright © 2019, The Authors

                This article is Open Access: CC BY license ( https://creativecommons.org/licenses/by/4.0/)

                History
                : 10 April 2019
                : 23 June 2019
                Categories
                Research

                patients with cancer,general practitioners,follow-up,electronic health records,data extraction,neoplasms,primary health care

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