Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA.
Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA.
J Cancer Surviv. 2023 Oct;17(5):1276-1285. doi: 10.1007/s11764-021-01159-8. Epub 2022 Jan 5.
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.
了解在癌症治疗向治疗后生存阶段过渡期间，既往疾病对未参保和未参保患者的医疗保健利用的影响。
利用电子健康记录数据，我们构建了一个在综合县卫生系统就诊的患者队列，该队列的就诊时间为 2010 年 1 月 1 日至 2016 年 12 月 31 日。在此期间，诊断患有非转移性乳腺癌或结直肠癌的 631 名成年患者（病例）按性别和 Charlson 合并症指数与至少有两种慢性病且在研究期间至少有一次到卫生系统就诊的非癌症患者（对照组）进行 1:1 匹配。条件固定效应泊松回归模型比较癌症患者和非癌症患者之间的初级保健和急诊部就诊次数以及完成[与未出现或错过]预约次数。
与非癌症患者相比，癌症患者的就诊次数明显较少（N=46965 与 85038）。癌症患者接受初级保健（IRR=0.25；95%CI：0.24，0.27）和急诊部就诊（IRR=0.57；95%CI：0.50，0.64）的可能性较低，但完成预约的可能性较高（AOR=4.83；95%CI：4.32，5.39）。与非癌症患者相比，在初级保健中就诊率较高的癌症患者更有可能去急诊部就诊（IRR=2.06；95%CI：1.52，2.80）。
卫生系统需要找到创新有效的解决方案，增加患有慢性病的癌症患者对初级保健的利用，以确保对慢性病和癌症的最佳管理。
应提倡在积极治疗癌症期间与初级保健提供者保持定期联系。
