Bastedo S J, Krzyzanowska M K, Moineddin R, Yun L, Enright K A, Grunfeld E
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto.
Institute for Clinical Evaluative Sciences, Toronto.
Curr Oncol. 2017 Apr;24(2):90-94. doi: 10.3747/co.24.3431. Epub 2017 Apr 27.
We used administrative health data to explore the impact of primary care physician (pcp) visits on acute-care service utilization by women receiving adjuvant chemotherapy for early-stage breast cancer (ebc).
Our population-based retrospective cohort study examined pcp visits and acute-care use [defined as an emergency room (er) visit or hospitalization] by women diagnosed with ebc between 2007 and 2009 and treated with adjuvant chemotherapy. Multivariate regression analysis was used to identify the effect of pcp visits on the likelihood of experiencing an acute-care visit.
Patients receiving chemotherapy visited a pcp significantly more frequently than they had before their diagnosis [relative risk (rr): 1.48; 95% confidence interval (ci): 1.44 to 1.53; < 0.001] and significantly more frequently than control subjects without cancer (rr: 1.51; 95% ci: 1.46 to 1.57; < 0.001). More than one third of pcp visits by chemotherapy patients were related to breast cancer or chemotherapy-related side effects. In adjusted multivariate analyses, the likelihood of experiencing an er visit or hospitalization increased in the days immediately after a pcp visit (rr: 1.92; 95% ci: 1.76 to 2.10; < 0.001).
During chemotherapy treatment, patients visited their pcp more frequently than control subjects did, and they visited for reasons related to their breast cancer or to chemotherapy-related side effects. Visits to a pcp by patients receiving chemotherapy were associated with an increased frequency of er visits or hospitalizations in the days immediately after the pcp visit. Those results suggest an opportunity to institute measures for early detection and intervention in chemotherapy side effects.
我们利用行政健康数据，探讨初级保健医生（PCP）诊疗对接受早期乳腺癌（EBC）辅助化疗的女性急性护理服务利用情况的影响。
我们基于人群的回顾性队列研究，考察了2007年至2009年间被诊断为EBC并接受辅助化疗的女性的PCP诊疗情况和急性护理使用情况（定义为急诊室就诊或住院）。采用多变量回归分析来确定PCP诊疗对急性护理就诊可能性的影响。
接受化疗的患者看PCP的频率显著高于诊断前（相对风险[RR]：1.48；95%置信区间[CI]：1.44至1.53；P<0.001），且显著高于无癌症的对照受试者（RR：1.51；95%CI：1.46至1.57；P<0.001）。化疗患者超过三分之一的PCP诊疗与乳腺癌或化疗相关副作用有关。在调整后的多变量分析中，PCP诊疗后的几天内，急诊室就诊或住院的可能性增加（RR：1.92；95%CI：1.76至2.10；P<0.001）。
在化疗期间，患者看PCP的频率高于对照受试者，且就诊原因与乳腺癌或化疗相关副作用有关。接受化疗的患者看PCP与PCP诊疗后的几天内急诊室就诊或住院频率增加有关。这些结果表明有机会采取措施早期发现和干预化疗副作用。
