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Primary and subspecialty care models of follow-up care delivery among colorectal cancer survivors

Haggstrom DA, Arora K, Oakley-Girvan. Primary and subspecialty care models of follow-up care delivery among colorectal cancer survivors. Poster session presented at: American Society of Clinical Oncology Annual Meeting; 2009 Jun 5; Chicago, IL.

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The Institute of Medicine recommends that the health care system consider both primary and specialty care models in delivering follow-up care to cancer survivors. Methods: Colorectal cancer (CRC) survivors in Northern California were surveyed 2-5 years after diagnosis, including 271 survivors with no recurrence who mainly saw either a primary care physician (PCP) or subspecialty physician (oncologist or surgeon). We analyzed specialty differences in patient sociodemographics, cancer stage, medical comorbidities, and patient perceptions of the quality of follow-up care (communication, care coordination, and office staff interactions) using chi- squared tests and simple regression models that incorporated sampling weights. Results: A minority (18.6%) of CRC cancer survivors stated that the doctor they most often saw for follow-up cancer care was a primary care physician (PCP). Among survivors who most often saw a subspecialty physician, 83% saw an oncologist and 17%, a surgeon. Survivors mainly seen by PCPs were more likely to be African-American than survivors seen by subspecialty physicians (18% vs. 3%, p < 0.0005) and to have Stage I disease (43% vs. 21%, p = 0.004). There was no significant difference in the number of medical comorbidities among patients seen by PCPs and subspecialists (2 or more comorbidities: 69% vs. 57%, p = 0.15). There were also no detectable specialty differences in survivors' reports and perceptions of the quality of follow-up care in relation to communication, care coordination, or office staff interactions. Conclusions: Models of health care delivery should consider how to balance care for CRC survivors between primary care and subspecialty physicians, especially among individuals with complex medical problems. Primary care models of care delivery appear uncommon and should be tested more widely. Racial disparities may be present in access to subspecialty care, although CRC survivors who see PCPs do not perceive lower quality of care.

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