Excess of health care use in general practice and of comorbid chronic conditions in cancer patients compared to controls

Lea Jabaaij,Marjan Van Den Akker,François G Schellevis

doi:10.1186/1471-2296-13-60

Abstract

BackgroundThe number of cancer patients and the number of patients surviving initial treatments is expected to rise. Traditionally, follow-up monitoring takes place in secondary care. The contribution of general practice is less visible and not clearly defined.This study aimed to compare healthcare use in general practice of patients with cancer during the follow-up phase compared with patients without cancer. We also examined the influence of comorbid conditions on healthcare utilisation by these patients in general practice.MethodsWe compared health care use of N=8,703 cancer patients with an age and gender-matched control group of patients without cancer from the same practice. Data originate from the Netherlands Information Network of General Practice (LINH), a representative network consisting of 92 general practices with 350,000 enlisted patients. Health care utilisation was assessed using data on contacts with general practice, prescription and referral rates recorded between 1/1/2001 and 31/12/2007. The existence of additional comorbid chronic conditions (ICPC coded) was taken into account.ResultsCompared to matched controls, cancer patients had more contacts with their GP-practice (19.5 vs. 11.9, p<.01), more consultations with the GP (3.5 vs. 2.7, p<.01), more home visits (1.6 vs. 0.4, p<.01) and they got more medicines prescribed (18.7 vs. 11.6, p<.01) during the follow-up phase. Cancer patients more often had a chronic condition than their matched controls (52% vs. 44%, p<.01). Having a chronic condition increased health care use for both patients with and without cancer. Cancer patients with a comorbid condition had the highest health care use.ConclusionWe found that cancer patients in the follow-up phase consulted general practice more often and suffered more often from comorbid chronic conditions, compared to patients without cancer. It is expected that the number of cancer patients will rise in the years to come and that primary health care professionals will be more involved in follow-up care. Care for comorbid chronic conditions, communication between specialists and GPs, and coordination of tasks then need special attention.

Highlights

The number of cancer patients and the number of patients surviving initial treatments is expected to rise
Cancer patients younger than 30 years of age did not differ from age-matched controls in the number of face to face consultations with the general practitioners (GPs), the number of home visits and referrals
Use of care in general practice We found that during the follow-up phase cancer patients have double the use of health care services in general practice compared to controls

Summary

Introduction

The number of cancer patients and the number of patients surviving initial treatments is expected to rise. This study aimed to compare healthcare use in general practice of patients with cancer during the follow-up phase compared with patients without cancer. Highest prevalence rates of almost all cancers are found among persons older than 55 years of age. While this age group comprises only 20% of the population in the United States, over 80% of the invasive cancers are found in this group [1]. With an increasing number of patients with cancer and an increasing number of cancer patients surviving for a longer period of time a reorganization of health care will be necessary. New roles for general practitioners (GPs) and other primary care professionals in cancer care might emerge, for example in follow-up care

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