RT Journal Article
SR Electronic
T1 Continuity of care in general practice at cancer diagnosis (COOC-GP study): a national cohort study of 2853 patients
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e88
OP e96
DO 10.3399/bjgp19X700805
VO 69
IS 679
A1 Aline Hurtaud
A1 Michèle Aubin
A1 Emilie Ferrat
A1 Julien Lebreton
A1 Elena Paillaud
A1 Etienne Audureau
A1 Sylvie Bastuji-Garin
A1 Christos Chouaid
A1 Philippe Boisnault
A1 Pascal Clerc
A1 Florence Canouï-Poitrine
YR 2019
UL http://bjgp.org/content/69/679/e88.abstract
AB Background At cancer diagnosis, it is unclear whether continuity of care (COC) between the patient and GP is safeguarded.Aim To identify patient–GP loss of COC around the time of, and in the year after, a cancer diagnosis, together with its determinants.Design and setting A post-hoc analysis of data from a prospective cohort of GPs in France, taken from a survey by the Observatoire de la Médecine Générale.Method A prospective GP cohort (n = 96) filed data on patients who were diagnosed with incident cancer between 1 January 2000 and 31 December 2010. COC was assessed by ascertaining the frequency of consultations and the maximal interval between them. (In France, patients see their referring/named GP in most cases.) A loss of COC was measured during the trimester before and the year after the cancer diagnosis, and the results compared with those from a 1-year baseline period before cancer had been diagnosed. A loss of COC was defined as a longer interval (that is, the maximum number of days) between consultations in the measurement periods than at baseline. Determinants of the loss in COC were assessed with univariate and multivariate logistic regression models.Results In total, 2853 patients were included; the mean age was 66.1 years. Of these, 1440 (50.5%) were women, 389 (13.6%) had metastatic cancer, and 769 (27.0%) had a comorbidity. The mean number of consultations increased up to, and including, the first trimester after diagnosis. Overall, 26.9% (95% confidence interval [CI] = 25.3 to 28.6) of patients had a loss of COC in the trimester before the diagnosis, and 22.3% (95% CI = 20.7 to 23.9) in the year after. Increasing comorbidity score was independently associated with a reduction in the loss of COC during the year after diagnosis (adjusted odds ratio [OR] comorbidity versus no comorbidity 0.61, 95% CI = 0.48 to 0.79); the same was true for metastatic status (adjusted OR metastasis versus no metastasis 0.49, 95% CI = 0.35 to 0.70).Conclusion As COC is a core value for GPs and for most patients, special care should be taken to prevent a loss of COC around the time of a cancer diagnosis, and in the year after.