Interventions to improve continuity of care in the follow-up of patients with cancer

Aubin, Michèle; Giguère, Anik; Martin, Mickaël; Verreault, René; Fitch, Margaret I.; Kazanjian, Arminée; Carmichael, Pierre‐Hugues

doi:10.1002/14651858.cd007672.pub2

Cited by 81 publications

(97 citation statements)

References 152 publications

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“…However, effective interventions to improve continuity of care, particularly for patients with cancer, have proved elusive 18. The results presented here suggest that ensuring continuity of care by community staff is seen as highly important by the family carers of patients dying at home, but such care continuity was often absent.…”

Section: Discussionmentioning

confidence: 80%

Dying at home: a qualitative study of family carers’ views of support provided by GPs community staff

et al. 2014

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BackgroundDying at home is the preference of many patients with life-limiting illness. This is often not achieved and a key factor is the availability of willing and able family carers.AimTo elicit family carers’ views about the community support that made death at home possible.Design and settingQualitative study in East Devon, North Lancashire, and Cumbria.MethodParticipants were bereaved family carers who had provided care at the end of life for patients dying at home. Semi-structured interviews were conducted 6–24 months after the death.ResultsFifty-nine bereaved family carers were interviewed (54% response rate; 69% female). Two-thirds of the patients died from cancer with median time of home care being 5 months and for non-cancer patients the median time for home care was 30 months. An overarching theme was of continuity of care that divided into personal, organisational, and informational continuity. Large numbers and changes in care staff diluted personal continuity and failure of the GPs to visit was viewed negatively. Family carers had low expectations of informational continuity, finding information often did not transfer between secondary and primary care and other care agencies. Organisational continuity when present provided comfort and reassurance, and a sense of control.ConclusionThe requirement for continuity in delivering complex end-of-life care has long been acknowledged. Family carers in this study suggested that minimising the number of carers involved in care, increasing or ensuring personal continuity, and maximising the informational and organisational aspects of care could lead to a more positive experience.

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Section: Discussionmentioning

confidence: 80%

Dying at home: a qualitative study of family carers’ views of support provided by GPs community staff

et al. 2014

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“…Three of the reviews focus on continuity of care and unscheduled secondary care 9 10 13. The reviews by Cabana and Hsiao looked at continuity of primary healthcare and unscheduled secondary care, but the data are over 5 years old.…”

Section: Discussionmentioning

confidence: 99%

“…However, both these reviews reflect the updated findings of our review, namely that continuity of care reduces unscheduled secondary care. The review by Aubin et al 9 only focuses on patients with cancer and considered studies across primary and secondary care.…”

Section: Discussionmentioning

confidence: 99%

Which features of primary care affect unscheduled secondary care use? A systematic review

et al. 2014

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ObjectivesTo conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care.SettingObservational studies at primary care practice level.ParticipantsStudies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition.Primary and secondary outcome measuresThe primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions.Results48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed.ConclusionsThe majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions.

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“…A similar conclusion was drawn in the review of Aubin et al on the effects of interventions to improve continuity of follow-up care for cancer patients. In this review, a shared care model was used in 14 of 63 studies, and even though some effects in separate studies were found, no clear conclusions could be drawn because the results were too mixed [35]. Again, just as in the review of Smith et al [7,18], the interventions were complex, which makes it hard to determine which elements of the intervention were effective and which were not.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Information Technology-Supported Shared Care for Patients With Chronic Disease: A Systematic Review

Kooij¹,

Groen²,

Harten³

2017

J Med Internet Res

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BackgroundIn patients with chronic disease, many health care professionals are involved during treatment and follow-up. This leads to fragmentation that in turn may lead to suboptimal care. Shared care is a means to improve the integration of care delivered by various providers, specifically primary care physicians (PCPs) and specialty care professionals, for patients with chronic disease. The use of information technology (IT) in this field seems promising.ObjectiveOur aim was to systematically review the literature regarding the effectiveness of IT-supported shared care interventions in chronic disease in terms of provider or professional, process, health or clinical and financial outcomes. Additionally, our aim was to provide an inventory of the IT applications' characteristics that support such interventions.MethodsPubMed, Scopus, and EMBASE were searched from 2006 to 2015 to identify relevant studies using search terms related to shared care, chronic disease, and IT. Eligible studies were in the English language, and the randomized controlled trials (RCTs), controlled trials, or single group pre-post studies used reported on the effects of IT-supported shared care in patients with chronic disease and cancer. The interventions had to involve providers from both primary and specialty health care. Intervention and IT characteristics and effectiveness—in terms of provider or professional (proximal), process (intermediate), health or clinical and financial (distal) outcomes—were extracted. Risk of bias of (cluster) RCTs was assessed using the Cochrane tool.ResultsThe initial search yielded 4167 results. Thirteen publications were used, including 11 (cluster) RCTs, a controlled trial, and a pre-post feasibility study. Four main categories of IT applications were identified: (1) electronic decision support tools, (2) electronic platform with a call-center, (3) electronic health records, and (4) electronic communication applications. Positive effects were found for decision support-based interventions on financial and health outcomes, such as physical activity. Electronic health record use improved PCP visits and reduced rehospitalization. Electronic platform use resulted in fewer readmissions and better clinical outcomes—for example, in terms of body mass index (BMI) and dyspnea. The use of electronic communication applications using text-based information transfer between professionals had a positive effect on the number of PCPs contacting hospitals, PCPs’ satisfaction, and confidence.ConclusionsIT-supported shared care can improve proximal outcomes, such as confidence and satisfaction of PCPs, especially in using electronic communication applications. Positive effects on intermediate and distal outcomes were also reported but were mixed. Surprisingly, few studies were found that substantiated these anticipated benefits. Studies showed a large heterogeneity in the included populations, outcome measures, and IT applications used. Therefore, a firm conclusion cannot be drawn. As IT applications are developed and imp...

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Interventions to improve continuity of care in the follow-up of patients with cancer

Cited by 81 publications

References 152 publications

Dying at home: a qualitative study of family carers’ views of support provided by GPs community staff

Dying at home: a qualitative study of family carers’ views of support provided by GPs community staff

Which features of primary care affect unscheduled secondary care use? A systematic review

The Effectiveness of Information Technology-Supported Shared Care for Patients With Chronic Disease: A Systematic Review

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