Promoting the Shared-Care Model for Adolescent and Young Adults With Cancer: Optimizing Referrals and Care Coordination With Primary Care Providers

Abstract

Background The “shared-care model” for patients with cancer involves care coordination between primary care providers (PCPs) and oncologists, with the goal of optimizing survivorship care. However, a high proportion of adolescent and young adult (AYA) cancer survivors do not have a PCP. Study objectives were to increase the percentage of AYAs with a PCP documented in the electronic medical record (EMR) via the use of a best practice advisory (BPA) or “stopgap” intervention; to increase communication between providers by the number of routed clinic notes; and to assess oncology providers’ attitudes/beliefs about the model and intervention. Methods Data were collected for the 6 months before implementation of the BPA to determine the percentage of AYAs with a PCP and the number of notes routed to providers (time point 1 [T1]). The same data were collected at time point 2 (T2) after the BPA had been implemented for 6 months. Oncology providers participated in an education video module and an online survey at T1 and a survey at T2. Results At T1, 47.1% of 756 AYAs had a documented PCP in the EMR. At T2, the percentage increased to 55.1% (P<.002). The number of routed notes did not change significantly from T1 to T2. Providers that completed the intervention survey agreed/strongly agreed that the shared-care model is a desirable model of care (T1 = 86%; T2 = 93%) and that a BPA is useful for facilitating PCP referrals (T1 = 76%; T2 = 39%). Conclusions This BPA is feasible for increasing the percentage of AYAs with a PCP documented in the EMR and could potentially lead to increased PCP referral and communication among providers for the benefit of long-term survivorship care. Providers generally agree with the shared-care model; however, the BPA implementation requires modification.

Community based Primary Care for Adolescents and Young Adults Transitioning From Pediatric Specialty Care: Results from a Scoping Review

“… 37 , 52 , 61 , 64 - 68 , 70 - 72 , 74 - 76 Common responsibilities of PCPs included: medication management (specifically prescribing and counseling), 35 , 52 , 61 , 64 , 67 , 70 , 71 making referrals to specialists and/or community resources, 35 , 64 , 70 , 71 , 73 managing mental health problems until more specialized services were needed or became available, 35 , 61 , 70 , 71 serving as care coordinator when multiple services/providers were involved, 64 , 71 and addressing “primary health care issues” (eg, immunizations; discussing lab results; managing flu-like symptoms, acute injury). 23 , 35 , 73 , 75 Often PCPs were comfortable with caring for AYAs until their symptoms reached a threshold wherein more expertise was desired/needed. 61 , 67 , 70 , 71 …”

Análises das Demandas e Cenários de Apoio para Sobreviventes de Câncer: Revisão Integrativa

“…No Quadro 2, foi realizada uma síntese dos artigos antes indicados e analisados 8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] . Identificou-se o predomínio de pesquisas de níveis de evidência 4 (80%), com publicações distribuídas dentro do período do estudo, porém, com hegemonia no ano de 2015, perfazendo 30% dos estudos.…”

General practitioners’ management of cancers in Australian adolescents and young adults

“…Notably, a higher proportion of these AYAs were classified as new to the practice (11.8%) relative to the overall BEACH sample (7.9%; 95% CI 7.7–8.1), perhaps because younger patients are less likely to consult GPs and to have a regular practice that they are linked to (Britt & Miller, ). This suggests that a considerable number of AYAs may have limited experience or familiarity with GPs managing their cancers – indeed, it is not uncommon for American AYAs (18–39 years) diagnosed with cancer to report not having a primary care physician (Kinahan et al, ). Additionally, 29.2% of the AYA cancers managed in this study were reportedly “new” cases, suggesting that a substantial part of GPs’ management of AYA cancers relates to the initial diagnosis.…”

“…Perhaps accordingly, GPs’ reported management strategies appeared to be more advisory, primarily providing counselling and education to patients and referring them to pathology, imaging or further specialist care. The high proportion of “old” cancers managed suggests that GPs are also involved in the ongoing care of AYA patients – an encouraging finding, as this lays the foundations for longer‐term follow‐up care as AYAs move into the survivorship phase (Kinahan et al, ). However, it is not clear whether these AYAs are returning to the same GP for ongoing care; it is possible that some are moving between medical practitioners, although the low proportion of AYAs who are new to practice suggests that this is relatively uncommon.…”