Reduced utilisation of specialist care among elderly cancer patients: a randomised study of a primary healthcare intervention.
The aim of this study was to evaluate the effect of an individual support (IS) intervention including intensified primary healthcare on the utilisation of specialist care among cancer patients, and to investigate if such an effect was modified by the patient's age (less than 70 years or 70 years and more). Newly diagnosed cancer patients (n=416) were randomised between the intervention and a control condition, and data were collected on the utilisation of specialist care within 3 months from inclusion. Intensified primary healthcare comprised extended information from the specialist clinics, and education and supervision in cancer care for general practitioners (GPs) and home-care nurses. The support given also included interventions designed to diminish problems of weight loss and psychological distress. The intervention reduced the number of admissions (NoA) and the days of hospitalisation (DoH) after adjustment for weight loss and psychological distress, but only for older patients. Older patients randomised to the intervention (n=82) experienced 393 fewer DoH than the older control patients (n=79). In addition, the proportion of older patients in the IS group who utilised acute specialist care was smaller compared with older control patients group. The conclusion is that older cancer patients' utilisation of specialist care may be reduced by intensified primary healthcare services.
Johansson
B
B
Department of Public Health and Caring Sciences, Uppsala University, S-751 83 Uppsala, Sweden. birgitta.johansson@pubcare.uu.se
Holmberg
L
L
Berglund
G
G
Brandberg
Y
Y
Hellbom
M
M
Persson
C
C
Glimelius
B
B
Sjödén
P O
PO
D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data*; D006766:Hospitals, County / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D013548:Sweden