Healthcare utilization of breast cancer patients following telephone-based consultations of oncology nurse navigator via telemedical care.

Gila Adler,Galit Kaufman,Tzahit Simon-Tuval,Sreeram V Ramagopalan

doi:10.1371/journal.pone.0216365

Gila Adler, Galit Kaufman + Show 2 more

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https://doi.org/10.1371/journal.pone.0216365

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Abstract

ObjectivesTo characterize breast cancer patients who received telephone-based consultations of oncology nurse navigator via telemedical care (TMC patients) and analyze their healthcare utilization (HCU) one year before and after receiving this service.MethodsA retrospective study among Maccabi Healthcare Services enrollees that were newly diagnosed during 2016 (n = 1035). HCU, demographic characteristics and comorbidities were obtained from computerized database. Multivariable ordered logit model was specified for the determinants of HCU by quarters. Independent variables included: annual number of telephone-based consultations, gap between diagnosis and first consultation, age, socio-economic status, eligibility for disability and income security benefits, and comorbidities.ResultsTwenty-two percent of our cohort were TMC patients. Compared to others, these patients were younger and had a lower prevalence of hypertension. A higher proportion of these patients received disability benefits, and a lower proportion received income security benefits. The total average annual HCU of TMC patients (n = 107) before first consultation was $8857 and increased to $44130 in the first year following it (p<0.001), predominantly due to a significant increase in outpatient visits ($20380 vs. $3502, p<0.001) and medication costs ($19339 vs. $1758, p<0.001). The multivariable model revealed that each additional telephone-based consultation decreased the likelihood to be in the lowest quarter of the HCU distribution by 1.1 percentage points (p = 0.015), and increased the likelihood to be in the upper quarter of the HCU distribution by 1.1 percentage points (p = 0.016).ConclusionsThere was a significant increase in outpatient care and medications usage following first consultation. Moreover, a more intense use of this service was associated with elevated HCU. This result may stem from the proactive nature of the telemedical care.

Highlights

Cancer, as the leading cause of morbidity and mortality in developed countries [1] imposes a heavy burden on health systems and economies [2,3,4,5,6,7,8,9,10,11]
The multivariable model revealed that each additional telephone-based consultation decreased the likelihood to be in the lowest quarter of the healthcare utilization (HCU) distribution by 1.1 percentage points (p = 0.015), and increased the likelihood to be in the upper quarter of the HCU distribution by 1.1 percentage points (p = 0.016)
A more intense use of this service was associated with elevated HCU

Summary

Introduction

As the leading cause of morbidity and mortality in developed countries [1] imposes a heavy burden on health systems and economies [2,3,4,5,6,7,8,9,10,11]. There is evidence that the first year after diagnosis is the costliest year in terms of healthcare utilization (HCU) [9,10,11]. Outpatient care is a substantial component of HCU [3, 7], and as expected, costs increase as the disease progresses [9, 10]. Diagnosis at early stages of breast cancer leads to better outcomes in terms of higher survival rates and lower costs of care [10, 11]. Consideration of primary prevention methods, allocation of coordinated economic resources, and planning for disease management for both secondary and tertiary prevention are essential

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