title: Population-based longitudinal study of follow-up care for patients with colorectal cancer in Nova Scotia.
abstract: OBJECTIVE
  The purpose of this study was to examine colorectal cancer (CRC) follow-up care in Nova Scotia, Canada. More specifically, the objectives were to describe adherence to two elements of follow-up guidelines (colonoscopies and physician visits) and to identify factors associated with receiving at least guideline-recommended care.
  
  
  METHODS
  All patients with stage II or III CRC undergoing curative-intent surgery in Nova Scotia, Canada, were identified through the provincial cancer registry and anonymously linked to additional administrative health databases. For a 3-year follow-up period, beginning 1 year after the diagnosis date, descriptive statistics were calculated for physician visits and colonoscopies. Factors associated with receiving at least guideline-recommended care were identified using logistic regression.
  
  
  RESULTS
  Most patients received follow-up care from multiple physician specialties. In year 3, 58.1% of patients received oncologist follow-up care. Guideline adherence for colonoscopies was 52.4%, whereas guideline adherence for physician visits decreased from 41.9% to 25.4%. Receipt of at least guideline-recommended care was inversely associated with age and comorbidity for colonoscopy and inversely associated with age for physician visits.
  
  
  CONCLUSIONS
  Receipt of follow-up care from oncologists and primary care physicians, prolonged oncologist care, and receipt of care inconsistent with guideline recommendations suggest there may be potential issues with inefficient use of cancer system resources and integration of guidelines into follow-up care practices in Nova Scotia. Transitioning routine follow-up to primary care could potentially increase guideline adherence by improving access to and continuity of care. CRC may be well suited to targeted knowledge translation strategies to improve guideline adherence.
authors.affiliation: Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada. robin.urquhart@cdha.nshealth.ca
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.forename: Amy
authors.initials: A
authors.lastname: Folkes
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Porter
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kendell
authors.forename: Martha
authors.initials: M
authors.lastname: Cox
authors.forename: Ron
authors.initials: R
authors.lastname: Dewar
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000628:therapy*; D003695:Delivery of Health Care; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D058007:Physicians, Primary Care; D011153:Population