Intensified primary cancer care: a randomized study of home care nurse contacts

Newly diagnosed cancer patients (n = 527) were randomised to intensified pr imary care or a control group. Intensified primary care comprised routines to improve general practitioners' and home care nurses' possibilities to su pport and monitor patients, i.e. increased information from specialist care , education and supervision in cancer care. The aims of this paper are to e valuate the effects of intensified primary care on cancer patients' home ca re nurse contacts, and to study if patients' use of home care services 6 mo nths after diagnosis can be predicted. The intervention resulted in a marke d increase of follow-up contacts. About 90% of intensified primary care pat ients reported such contacts, compared to 26% of control patients. The resu lts indicate that standard care does not routinely include follow-up contac ts, not even for the oldest (80+ years) or those with advanced disease. Onl y 27% and 36% of these groups of control patients reported follow-ups. Logi stic regression analysis identified intensified primary care as the stronge st predictor for reporting a continuing contact 6 months after diagnosis. I ntensified primary care patients were 14 times more likely than controls to report a such contact. The strongest predictor of a continuing contact in the intensified primary care group was high age. Patients with advanced dis ease were more likely than patients with non-advanced disease to report a c ontinuing contact, and living in a rural district was positively associated with reporting a contact. A majority of the patients (70%) assessed the ti me for the first contact as the 'right time' and estimated that the nurse g ave expected support to a very large or large extent (67%). The results sug gest that routines like those implemented through intensified primary care may be an effective strategy to increase the accessibility and continuity o f care, especially for elderly people and for patients with a need for long -term contacts.