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Research ArticleOriginal Research

The Impact of Primary Care Physicians on Follow-up Care of Underserved Breast Cancer Survivors

Rose C. Maly, Yihang Liu, Allison L. Diamant and Amardeep Thind
The Journal of the American Board of Family Medicine November 2013, 26 (6) 628-636; DOI: https://doi.org/10.3122/jabfm.2013.06.120345
Rose C. Maly
From the Department of Family Medicine (RCM, YL), the Department of Medicine, Division of General Internal Medicine and Health Services Research (ALD), David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles; and the Departments of Family Medicine and Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada (AT).
MD, MSPH
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Yihang Liu
From the Department of Family Medicine (RCM, YL), the Department of Medicine, Division of General Internal Medicine and Health Services Research (ALD), David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles; and the Departments of Family Medicine and Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada (AT).
MA, MS, MD
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Allison L. Diamant
From the Department of Family Medicine (RCM, YL), the Department of Medicine, Division of General Internal Medicine and Health Services Research (ALD), David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles; and the Departments of Family Medicine and Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada (AT).
MD, MSHS
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Amardeep Thind
From the Department of Family Medicine (RCM, YL), the Department of Medicine, Division of General Internal Medicine and Health Services Research (ALD), David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles; and the Departments of Family Medicine and Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada (AT).
MD, PhD
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  • Article
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Article Figures & Data

Tables

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    Table 1. Descriptive Statistics of the Study Sample (n = 579)
    DemographicsValue
    Age (years)
        Mean (SD)51.2 (9.1)
        Range25.0–85.0
    Ethnicity
        White196 (33.9)
        Less-acculturated Latina275 (47.5)
        More-acculturated Latina33 (5.7)
        African American25 (4.3)
        Asian/Pacific Islander50 (8.6)
    High school graduate
        No235 (40.6)
        Yes344 (59.4)
    Married/partnered
        No284 (49.1)
        Yes295 (51.0)
    Comorbidity
        None409 (70.6)
        Any170 (29.4)
    Stage
        067 (11.6)
        I152 (26.3)
        II267 (46.1)
        III93 (16.1)
    Hormone therapy
        No168 (29.0)
        Yes411 (71.0)
    Financial adequacy
        No358 (61.8)
        Yes221 (38.2)
    Did not get medical care because of competing life needs
        No451 (77.9)
        Yes128 (22.1)
    Doctor visit group
        PCP only40 (7.0)
        Surgeon/cancer specialist only100 (17.3)
        Both PCP and surgeon/cancer specialist439 (75.8)
    Access to medical care
        Very easy/somewhat easy358 (61.8)
        Very difficult/somewhat difficult221 (38.2)
    • Data are n (%) unless otherwise indicated.

    • PCP, primary care provider; SD, standard deviation.

    • View popup
    Table 2. Unadjusted Analysis of Preventive Care by Provider (n = 579)
    Preventive CarePCP Only (%)Surgeon/Cancer Specialist Only (%)Both PCP and Surgeon/Cancer Specialist (%)P Value*
    Annual mammography77.571.083.0.015
    Pap in the past 2 years77.573.080.9.207
    Colonoscopy63.327.652.3.0007
    • ↵* χ2 Test.

    • Pap, Papanicolaou test; PCP, primary care provider.

    • View popup
    Table 3. Multivariate Logistic Regression Analysis of Preventive Care by Patient Groups (n = 579)
    Annual MammographyPap in the Past 2 YearsColonoscopy (n = 371)
    AOR (95% CI)P ValueAOR (95% CI)P ValueAOR (95% CI)P Value
    Age >50 years1.34 (0.86–2.11).2000.29 (0.18–0.47)<.00011.03 (0.99–1.07).095
    Any comorbidity (yes)*1.49 (0.89–2.47).1270.71 (0.45–1.12).1481.30 (0.82–2.05).269
    Married/partnered (yes)1.42 (0.89–2.27).1401.35 (0.85–2.15).2080.96 (0.61–1.53).870
    High school graduate (yes)0.77 (0.44–1.36).3690.87 (0.49–1.55).6391.21 (0.69–2.11).503
    Ethnicity (reference: white)
        African American0.99 (0.36–2.74).9851.71 (0.60–4.89).3151.38 (0.42–4.53).593
        Less-acculturated Latina1.73 (0.94–3.18).0772.76 (1.50–5.08).0010.72 (0.40–1.30).273
        More-acculturated Latina0.76 (0.32–1.81).5363.44 (1.10–10.75).0341.48 (0.55–3.97).438
        Other1.43 (0.62–3.31).4091.56 (0.71–3.46).2690.95 (0.42–2.18).903
    Stage III0.63 (0.36–1.10).1060.88 (0.49–1.58).6581.09 (0.58–2.02).794
    Hormone therapy (yes)1.65 (1.04–2.62).0331.98 (1.23–3.18).00471.30 (0.80–2.13.296
    Doctor visit group (reference: surgeon/cancer specialist only)
        PCP only2.67 (0.84–5.74).1092.90 (1.05–8.04).0402.99 (1.5–8.51).041
        Both PCP and cancer specialist2.20 (1.51–4.72).00082.24 (1.22–4.10).0092.17 (1.10–4.30).026
    Financial adequacy (yes)0.89 (0.55–1.42).6121.28 (0.79–2.09).3210.78 (0.48–1.25).296
    Competing life needs (yes)0.81 (0.48–1.38).4430.91 (0.52–1.58).7411.61 (0.92–2.82).099
    Access to medical care (reference: very difficult/somewhat difficult )0.66 (0.41–1.09).1040.95 (0.58–1.55).8261.73 (1.06–2.83).029
    • ↵* One or more major comorbidity vs. none.

    • AOR, adjusted odds ratio; CI, confidence interval; Pap, Papanicolaou test; PCP, primary care provider.

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The Journal of the American Board of Family     Medicine: 26 (6)
The Journal of the American Board of Family Medicine
Vol. 26, Issue 6
November-December 2013
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The Impact of Primary Care Physicians on Follow-up Care of Underserved Breast Cancer Survivors
Rose C. Maly, Yihang Liu, Allison L. Diamant, Amardeep Thind
The Journal of the American Board of Family Medicine Nov 2013, 26 (6) 628-636; DOI: 10.3122/jabfm.2013.06.120345

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The Impact of Primary Care Physicians on Follow-up Care of Underserved Breast Cancer Survivors
Rose C. Maly, Yihang Liu, Allison L. Diamant, Amardeep Thind
The Journal of the American Board of Family Medicine Nov 2013, 26 (6) 628-636; DOI: 10.3122/jabfm.2013.06.120345
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Keywords

  • Breast Cancer
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  • Quality of Health Care
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