Patient, Primary Care Physician and Specialist Expectations of Primary Care Physician Involvement in Cancer Care

Background  

In Canada, many health authorities recommend that primary care physicians (PCP) stay involved throughout their patients’ cancer journey to increase continuity of care. Few studies have focused on patient and physician expectations regarding PCP involvement in cancer care.     

Primary Care of the Transplant Patient

A total of 153,245 patients are living with a solid organ transplant in the US. In addition, patients are experiencing high 5-year survival rates after transplantation. Thus, primary care physicians will be caring for transplanted patients. The aim of this review is to update primary care physicians on chronic diseases, screening for malignancy, immunizations, and contraception in the transplant patient. Several studies on the treatment of hypertension and hyperlipidemia demonstrate that most agents used to treat the general population also can be used to treat transplant recipients. Little information exists on the medical management of diabetes in the transplant population, but experts in the area believe that the treatment of diabetes should be similar. Transplant recipients are at increased risk for all malignancies. Aggressive screening should be employed for all cancers with a proven screening benefit. Killed immunizations are safe for the transplant population, but live virus vaccines should be avoided. Women of childbearing age should be counseled about the impact of immunosuppressants on the efficacy and side effects of contraception.     

医学整合全程关爱

2013年长城会的主题＂医学整合,全程关爱（Integrated Medicine ＆ Patient Centred Care）＂是对医疗服务模式和医疗服务文化的探讨,强调＂整合的医疗服务模式（Integrated Medicine）＂和＂以患者为中心的服务（Patient-centered Care）＂.整合医疗服务模式（Integrated Medicine）指不同级别、不同专业领域的医疗机构实现有效沟通,为患者提供基于团队的医疗服务（Team-based Care）.患者常合并多种疾病,复杂的病情需不同专业的协作;从住院治疗到出院康复,无缝隙看护需要连续的医疗服务链.团队协作和医疗服务的整合是现代心血管疾病治疗的核心,是提高医疗质量、降低医疗费用、改善患者健康状况的必由之路.以患者为中心的医疗服务要求医生很好理解患者的价值观,除了要问＂What is the matter？＂外,还要问＂What matters to you？＂要帮助患者理解不同检查和治疗措施的风险和获益,鼓励患者参与诊疗康复过程,实现医患共同决策（Shared Decision-making,SDM）.     

High Medical Cost Burdens, Patient Trust, and Perceived Quality of Care

BACKGROUND  The financial burden of medical care expenses is increasing for American families. However, the association between high medical cost burdens and patient trust in physicians is not known. OBJECTIVE  To examine the association between high medical cost burdens and self-reported measures of patient trust and perceived quality of care. METHODS  Cross-sectional household survey based on random-digit dialing and conducted largely by telephone, supplemented by in-person interviews of households with no telephones. The sample for this analysis includes 32,210 adults who reported having a physician as their regular source of care. Measures of patient trust include overall trust, confidence in being referred to a specialist, and belief that the physician uses more services than necessary. Perceived quality measures include thoroughness of exam, ability to listen, and ability to explain. RESULTS  In adjusted analyses, persons with high medical cost burdens had greater odds of lacking trust in their physician to put their needs above all else (OR = 1.43, CI = 1.19, 1.73), not referring them to specialists (OR = 1.39, CI = 1.22, 1.58), and performing unnecessary tests (OR = 1.42, CI = 1.20, 1.62). Patients with high medical cost burdens also had more negative assessments of the thoroughness of care they receive from their physician (OR = 1.26, CI = 1.02, 1.56). The association of high medical cost burdens with patient trust and perceived quality of care was greatest for privately insured persons. CONCLUSION  The rising cost of medical care threatens a vital aspect of the effective delivery of medical care–patient trust in their physician and continuity of care. Exposing patients to more of the costs could lead to greater skepticism and less trust of physicians’ decision-making, thereby making health-care delivery less effective.     

Electronic Health Record Use,Intensity of Hospital Care,and Patient Outcomes

Objective

Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes.

Methods

We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed “electronic health record interactions.” Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates.

Results

Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25).

Conclusions

Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity.