Views of primary care providers on follow-up care of cancer patients.

BACKGROUND AND OBJECTIVES: Primary care providers (PCPs) are often involved in the care of cancer survivors. This study asked PCPs about their role in the follow-up care of breast and colorectal cancer patients and elicited opinions on improving the transfer of care from oncologists to PCPs. METHODS: A total of 175 PCPs in a large health care system with an electronic medical record system were mailed a questionnaire that addressed (1) their comfort and confidence regarding surveillance for cancer recurrence, (2) when patients should be seen in primary care, (3) evaluation of the transfer of care, (4) potential problems with that process, and (5) suggestions for improving that process. RESULTS: The response rate was 75.4%. Overall, 52% were comfortable having responsibility for surveillance of cancer recurrence, and 43% were confident they are following standard guidelines for cancer recurrence. Both of the aforementioned measures increased with years of practice. More than half rated the current transfer of care from oncologist to PCP as fair or poor. The most common problems identified were uncertainty regarding the type (62.6% for breast, 56.5% for colorectal), frequency (72.5%, 66.4%), and duration (74.8%, 67.2%) of surveillance testing. CONCLUSIONS: Levels of comfort, confidence, and satisfaction were generally low. PCPs need more specific guidance regarding surveillance for cancer recurrence.

A nurse-based pilot program to reduce cardiovascular risk factors in a primary care setting.

OBJECTIVE: To evaluate the effectiveness of a nurse-based cardiovascular disease (CVD) risk factor reduction program among patients at a primary care outpatient clinic. STUDY DESIGN: Preintervention and postintervention longitudinal, prospective pilot study to evaluate patients' achievement of CVD risk factor reduction. PATIENTS AND METHODS: A total of 436 patients at a primary care clinic in suburban Minneapolis, Minnesota, were enrolled in 2 years; 286 patients were followed up with additional visits. The nurse intervention included comprehensive CVD risk assessment, patient education, and counseling. Algorithms guided the development of individualized care plans based on laboratory test values, blood pressure readings, tobacco use, and history of cardiovascular events. Physicians were consulted for serious changes in patients' medical conditions or for medication changes. Three measures were compared from baseline to the end of the program: blood pressure, low-density lipoprotein cholesterol levels, and tobacco use. RESULTS: Statistically significant reductions were achieved from baseline to the final nurse visit in systolic blood pressure (from 155.8 to 143.4 mm Hg), diastolic blood pressure (from 94.4 to 84.0 mm Hg), and dyslipidemia (low-density lipoprotein cholesterol, from 4.15 to 3.80 mmol/L [from 160 to 147 mg/dL]) (P < .001 for all). Of the 40 tobacco users who participated in the program, 12 discontinued use (30%). CONCLUSIONS: This pilot study provides preliminary evidence of the effectiveness of a nurse-based CVD risk reduction program. Further study is needed to target high-risk patients and to compare results in the nurse intervention group with those in patients receiving usual care.