TY - JOUR
T1 - Patients’ Perceived Continuity of Care and Adherence to Oral Anticancer Therapy
T2 - a Prospective Cohort Mediation Study
AU - Cohen Castel, Orit
AU - Dagan, Efrat
AU - Keinan–Boker, Lital
AU - Low, Marcelo
AU - Shadmi, Efrat
N1 - Publisher Copyright: © 2021, Society of General Internal Medicine.
PY - 2021/6
Y1 - 2021/6
N2 - BACKGROUND: Oral anticancer therapy (OACT) poses adherence-related challenges to patients while generating a setting in which both primary care physicians (PCPs) and oncologists are involved in the active treatment of cancer. Continuity of care (COC) was shown to be associated with medication adherence. While maintaining COC is a central role of the PCP, how this affects continuity with oncologists, and jointly affects OACT adherence, is yet unknown.OBJECTIVES: To explore how aspects of COC act together to promote OACT adherence. Specifically, to examine whether better personal continuity with the PCP leads to better personal continuity with the oncologist, which together lead to better cross-boundary continuity between the oncologist and the PCP, jointly leading to good adherence to OACT.DESIGN AND SETTING: A prospective cohort study conducted in five oncology centers in Israel. A bootstrapping method was used to test the serial mediation model.PARTICIPANTS: Adult patients (age > 18 years) receiving a first OACT prescription (n = 119) were followed for 120 days.MAIN MEASURES: The Nijmegen Continuity Questionnaire was used to assess patients' perceived personal and cross-boundary continuity. The medication possession ratio was used to measure adherence.KEY RESULTS: Better personal continuity with the PCP was associated with better personal continuity with the oncologist (B = 0.35, p < 0.001), which was associated with better cross-boundary continuity (B = 0.33, p < 0.001), which, in turn, was associated with good adherence to OACT (B = 0.46, p = 0.03). Additionally, the indirect effect of personal continuity with the PCP on adherence to OACT through the mediation of personal continuity with the oncologist and cross-boundary continuity was found to be statistically significant (B = 0.053, 95% CI 0.0006-0.17).CONCLUSIONS: In a system where the PCP is the case manager, cancer patients' perceived personal continuity with the PCP has an essential role for initiating a sequence of care delivery events that positively affect OACT adherence.
AB - BACKGROUND: Oral anticancer therapy (OACT) poses adherence-related challenges to patients while generating a setting in which both primary care physicians (PCPs) and oncologists are involved in the active treatment of cancer. Continuity of care (COC) was shown to be associated with medication adherence. While maintaining COC is a central role of the PCP, how this affects continuity with oncologists, and jointly affects OACT adherence, is yet unknown.OBJECTIVES: To explore how aspects of COC act together to promote OACT adherence. Specifically, to examine whether better personal continuity with the PCP leads to better personal continuity with the oncologist, which together lead to better cross-boundary continuity between the oncologist and the PCP, jointly leading to good adherence to OACT.DESIGN AND SETTING: A prospective cohort study conducted in five oncology centers in Israel. A bootstrapping method was used to test the serial mediation model.PARTICIPANTS: Adult patients (age > 18 years) receiving a first OACT prescription (n = 119) were followed for 120 days.MAIN MEASURES: The Nijmegen Continuity Questionnaire was used to assess patients' perceived personal and cross-boundary continuity. The medication possession ratio was used to measure adherence.KEY RESULTS: Better personal continuity with the PCP was associated with better personal continuity with the oncologist (B = 0.35, p < 0.001), which was associated with better cross-boundary continuity (B = 0.33, p < 0.001), which, in turn, was associated with good adherence to OACT (B = 0.46, p = 0.03). Additionally, the indirect effect of personal continuity with the PCP on adherence to OACT through the mediation of personal continuity with the oncologist and cross-boundary continuity was found to be statistically significant (B = 0.053, 95% CI 0.0006-0.17).CONCLUSIONS: In a system where the PCP is the case manager, cancer patients' perceived personal continuity with the PCP has an essential role for initiating a sequence of care delivery events that positively affect OACT adherence.
KW - Adult
KW - Continuity of Patient Care
KW - Humans
KW - Israel
KW - Medical Oncology
KW - Middle Aged
KW - Physicians, Primary Care
KW - Prospective Studies
KW - adherence
KW - continuity of care
KW - oral anticancer therapy
UR - http://www.scopus.com/inward/record.url?scp=85103205295&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s11606-021-06704-w
DO - https://doi.org/10.1007/s11606-021-06704-w
M3 - مقالة
C2 - 33768501
SN - 0884-8734
VL - 36
SP - 1525
EP - 1532
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 6
ER -
