Reduced utilisation of specialist care among elderly cancer patients: a randomised study of a primary healthcare intervention

The aim of this study was to evaluate the effect of an individual support ( IS) intervention including intensified primary healthcare on the utilisatio n of specialist care among cancer patients, and to investigate if such an e ffect was modified by the patient's age ( < 70 years/ greater than or equal to 70 years). Newly diagnosed cancer patients (n = 416) were randomised be tween the intervention and a control condition, and data were collected on the utilisation of specialist care within 3 months from inclusion. Intensif ied primary healthcare comprised extended information from the specialist c linics, and education and supervision in cancer care for general practition ers (GPs) and home-care nurses. The support given also included interventio ns designed to diminish problems of weight loss and psychological distress. The intervention reduced the number of admissions (NoA) and the days of ho spitalisation (DoH) after adjustment for weight loss and psychological dist ress, but only for older patients. Older patients randomised to the interve ntion (n = 82) experienced 393 fewer DoH than the older control patients (n = 79). In addition, the proportion of older patients in the IS group who u tilised acute specialist care was smaller compared with older control patie nts group. The conclusion is that older cancer patients' utilisation of spe cialist care may be reduced by intensified primary healthcare services. (C) 2001 Elsevier Science Ltd. All rights reserved.