When to Repatriate? Clinicians’ Perspectives on the Transfer of Patient Management from Specialty to Primary Care

Combler le fossé entre les soins oncologiques et communautaires grâce à une évaluation pancanadienne des pratiques en vigueur

“…Le présent projet vise justement à produire des recommandations qui combleront ce fossé. Selon Cheung et collègues (2013), lorsqu'il est question de cancers complexes, les médecins de première ligne ne possèdent peut-être pas les connaissances, la formation et l'expérience nécessaires pour gérer les problèmes et offrir des soins de suivi adéquats (notamment les examens de surveillance de la récidive), ce que confirment d'autres auteurs (Ackerman et al, 2014;Dawes et al, 2015;Del Guidice et al, 2009;Nissen et al, 2007;Salz et al, 2012). Toutefois, de nombreuses études réalisées au Canada et ailleurs dans le monde ont montré que le médecin de première ligne demeure le coordonnateur principal des soins pendant la période de survie et qu'il peut prodiguer efficacement les soins dans les cas de cancer à faible risque (Del Guidice et al, 2009;Mao et al, 2009;Grunfeld et al, 1995Grunfeld et al, , 1996Grunfeld et al, , 1999Grunfeld et al, , 2006Sisler, Brown et Stewart, 2004;Wattchow et al, 2006;Wood, 1993).…”

Prescriber Continuity and Disease Control of Older Adults

“…Over the course of their enrollment in the traditional fee-for-service (FFS) program, the care of many MCC beneficiaries becomes fragmented as they are referred to specialists with complementary expertise to address newly diagnosed conditions or acute exacerbations of existing conditions. Some specialists will repatriate a beneficiary back to the primary care provider 5 after addressing the issues that prompted referral, while other providers will decide to co-manage a beneficiary with the primary care provider.…”

“…Clinically appropriate referrals to multiple specialists may compromise the continuity of care for beneficiaries and create care plans that patients may find challenging to reconcile 3,4 , unless specialists proactively coordinate care or repatriate patients back to the primary care provider who initiated the referral. 5 In numerous studies, more continuous care (measured as a higher concentration of outpatient visits with fewer providers) has been associated with lower hospital admission rates and lower health expenditures. [6][7][8][9][10] Having fewer prescribers (as opposed to providers) has also been associated with lower rates of hospital admission and emergency department visits in a cohort of Veterans 11 and with lower rates of medication utilization.…”

Bridging the gap from the oncology setting to community care through a cross-Canada environmental scan

“…It is recognized by Cheung et al (2013) and supported by other authors (Ackerman et al, 2014;Dawes et al, 2015;Del Guidice et al, 2009;Nissen et al, 2007;Salz et al, 2012) that primary care physicians may not be equipped with the knowledge, education, and experience to confidently handle issues and provide adequate follow-up care (to include surveillance testing for cancer recurrence) for complex disease groups. However, many studies in Canada and from other parts of the world have shown that the primary care physician remains the primary coordinator of care during cancer survivorship, and that care can effectively be provided by the primary care physician for low-risk cancer groups (Del Guidice et al, 2009;Mao et al, 2009;Grunfeld et al, 1995Grunfeld et al, , 1996Grunfeld et al, , 1999Grunfeld et al, , 2006Sisler, Brown & Stewart, 2004;Wattchow et al, 2006;Wood, 1993).…”