Rahman Md Mijanur, Jahan Shafkat, Koczwara Bogda, Iddawela Mahesh, Chan Raymond J, Thornton-Benko Elysia, Garvey Gail, Hart Nicolas H
The Daffodil Centre, University of Sydney and Cancer Council NSW, NSW, Australia.
School of Public Health, Faculty of Medicine, The University of Queensland, Qld, Australia.
Aust Health Rev. 2024 Dec;48(6):626-633. doi: 10.1071/AH24121.
Objective Chronic disease is common in people with cancer. However, the utilisation of Medicare chronic disease management (CDM) items for cancer patients in Australia remains unexplored. This study investigates Medicare CDM item numbers relating to people with cancer, including general practitioner (GP) and allied health CDM item numbers, and any associated sociodemographic factors. Methods Data from 86,571 people with cancer registered in the Queensland Cancer Registry between July 2011 and June 2015 and the CDM items codes from Medical Benefits Scheme records until 2018 were analysed. This includes utilisation of General Practitioner Management Plans (GPMP) and Team Care Arrangements (TCAs), reviews of GPMPs and TCAs, and engagement with allied health services until June 2018 following a cancer diagnosis. Results In total 47,615 (55%) and 43,286 (50%) people with cancer initiated at least one GPMP and TCA, respectively, with 31,165 (36%) receiving at least one review, and 36,359 (42%) utilising at least one allied health service (e.g. physiotherapists (41%), podiatrists (27%), exercise physiologists (19%)) with variations by cancer type. While people with cancer from disadvantaged socioeconomic groups had a higher likelihood of receiving GPMP (odds ratio, OR: 1.16, 95% confidence interval, CI: 1.11-1.21) and TCA (OR: 1.12, 95% CI: 1.07-1.16), they were less likely to utilise allied health services (OR: 0.89, 95% CI: 0.85-0.93). People with cancer living in remote areas were less likely to receive TCA (OR: 0.84, 95% CI: 0.80-0.88) or utilise allied health services (OR: 0.63, 95% CI: 0.60-0.67) than those in metropolitan areas. Conclusion Our findings underscore the need to examine uptake and implementation patterns of CDM items, especially in relation to clinical, social, and service provider-level factors and related potential barriers. Further exploration is warranted to understand whether people with cancer's care needs are being met and ways to optimise the supportive care of these people.
目的 慢性病在癌症患者中很常见。然而，澳大利亚癌症患者对医疗保险慢性病管理（CDM）项目的利用情况仍未得到研究。本研究调查了与癌症患者相关的医疗保险CDM项目编号，包括全科医生（GP）和专职医疗CDM项目编号，以及任何相关的社会人口学因素。方法 分析了2011年7月至2015年6月在昆士兰癌症登记处登记的86571名癌症患者的数据，以及截至2018年医疗福利计划记录中的CDM项目代码。这包括全科医生管理计划（GPMP）和团队护理安排（TCA）的使用情况、GPMP和TCA的复查情况，以及癌症诊断后至2018年6月期间与专职医疗服务的接触情况。结果 共有47615名（55%）和43286名（50%）癌症患者分别启动了至少一项GPMP和TCA，其中31165名（36%）接受了至少一次复查，36359名（42%）使用了至少一项专职医疗服务（如物理治疗师（41%）、足病医生（27%）、运动生理学家（19%）），不同癌症类型存在差异。虽然来自社会经济弱势群体的癌症患者更有可能接受GPMP（优势比，OR：1.16，95%置信区间，CI：1.11 - 1.21）和TCA（OR：1.12，95%CI：1.07 - 1.16），但他们使用专职医疗服务的可能性较小（OR：0.89，95%CI：0.85 - 0.93）。与大城市地区相比，居住在偏远地区的癌症患者接受TCA的可能性较小（OR：0.84，95%CI：0.80 - 0.88）或使用专职医疗服务的可能性较小（OR：0.63，95%CI：0.60 - 0.67）。结论 我们的研究结果强调了检查CDM项目的采用和实施模式的必要性，特别是与临床、社会和服务提供者层面的因素以及相关潜在障碍有关的方面。有必要进一步探索以了解癌症患者的护理需求是否得到满足以及优化这些患者支持性护理的方法。
