Healthcare utilization in women after abdominal surgery for ovarian cancer.
BACKGROUND
Women undergoing surgery for ovarian cancer are severely ill and are high users of health services. Contributing to these increased utilization rates are the multiple modalities used to treat ovarian cancer and the complications and side effects from those treatments.


OBJECTIVE
The purpose of this study was to evaluate the effectiveness of an intervention provided by advanced practice nurses and a psychiatric consultation-liaison nurse on patients' self-report of healthcare utilization compared with an attention control intervention in women undergoing surgery for a suspected diagnosis of ovarian cancer.


METHODS
A two-group, experimental, longitudinal design was used to compare women who were assigned randomly to the intervention group or to an attention control group at baseline within 48 hours after surgery and 1, 3, and 6 months after surgery. Healthcare utilization was measured as the number of self-reported inpatient admissions and outpatient visits, including emergency room visits, oncology outpatient visits, and primary care visits. Nurse interventions consisted of 16 contacts: symptom management, counseling, education, direct nursing care, coordination of resources, and referrals. The attention control interventions consisted of nine contacts that included instructions on use of a symptom management toolkit and strategies on how to manage symptoms.


RESULTS
There were no differences in hospitalizations and oncology outpatient visits between the two groups. The main finding of this study was a significant difference in the number of primary care visits between the two groups. Women in the attention control group went to their primary care providers more often than the intervention group. The women who reported more visits also reported more depressive symptoms. In addition, a trend was found in the number of emergency room visits between the two groups. The intervention group visited the emergency room more often because the nurse instructed patients to go when they recognized symptoms that needed urgent care after hours.


CONCLUSIONS
Women in the intervention group appropriately used the emergency room to manage their problems after hours, whereas more women in the attention control group reported significantly more primary care visits. These findings highlight the need for healthcare providers representing various disciplines to coordinate services across specialties, especially for women who have depressive symptoms.
School of Nursing, Yale University, New Haven, Connecticut 06536-0740, USA. ruth.mccorkle@yale.edu
Ruth
R
McCorkle
Sangchoon
S
Jeon
Elizabeth
E
Ercolano
Peter
P
Schwartz
D057179:Advanced Practice Nursing / Q000458:organization & administration*; D000368:Aged; D003237:Connecticut; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D009859:Oncology Nursing / Q000458:organization & administration*; D010051:Ovarian Neoplasms / Q000451:nursing* / Q000523:psychology / Q000601:surgery; D010353:Patient Education as Topic / Q000458:organization & administration; D011182:Postoperative Care / Q000451:nursing; D011320:Primary Health Care / Q000706:statistics & numerical data; D011568:Psychiatric Nursing / Q000458:organization & administration*; D012044:Regression Analysis; D014930:Women / Q000193:education / Q000523:psychology