Insurance, chronic health conditions, and utilization of primary and specialty outpatient services: a Childhood Cancer Survivor Study report

Emily L. Mueller, Elyse R. Park, Anne C. Kirchhoff, Karen Kuhlthau, Paul C. Nathan, Giselle K. Perez, Julia Rabin, Raymond Hutchinson, Kevin C. Oeffinger, Leslie L. Robison, Gregory Armstrong, Wendy M. Leisenring, Karen Donelan

Research output: Contribution to journalArticle

Abstract

Purpose: Survivors of childhood cancer require life-long outpatient healthcare, which may be impacted by health insurance. This study sought to understand survivors’ utilization of outpatient healthcare provider services. Methods: The study examined cross-sectional survey data using an age-stratified sample from the Childhood Cancer Survivor Study of self-reported annual use of outpatient services. Multivariable logistic regression analyses were used to identify risk factors associated with utilization of services. Results: Six hundred ninety-eight survivors were surveyed, median age 36.3 years (range 22.2–62.6), median time from diagnosis 28.8 years (range 23.1–41.7). Almost all (93%) of survivors had at least one outpatient visit during the previous year; 81.3% of these visits were with a primary care providers (PCP), 54.5% were with specialty care physicians, 30.3% were with nurse practitioner/physician’s assistants (NP/PA), and 14.2% were with survivorship clinic providers. Survivors with severe to life-threatening chronic health conditions had greater odds of utilizing a specialty care physician (OR = 5.15, 95% CI 2.89–9.17) or a survivorship clinic (OR = 2.93, 95% CI 1.18–7.26) than those with no chronic health conditions. Having health insurance increased the likelihood of seeking care from NP/PA (private, OR = 2.76, 95% CI 1.37–5.58; public, OR = 2.09, 95% CI 0.85–5.11), PCP (private, OR = 7.82, 95% CI 3.80–13.10; public, OR = 7.24, 95% CI 2.75–19.05), and specialty care (private, OR = 2.96, 95% CI 1.48–5.94; public, OR = 2.93, 95% CI 1.26–6.84) compared to without insurance. Conclusion: Most childhood cancer survivors received outpatient care from a PCP, but a minority received care from a survivorship clinic provider. Having health insurance increased the likelihood of outpatient care. Implications for Cancer Survivors: Targeted interventions in the primary care setting may improve risk-based, survivor-focused care for this vulnerable population.

Original languageEnglish (US)
Pages (from-to)639-646
Number of pages8
JournalJournal of Cancer Survivorship
Volume12
Issue number5
DOIs
StatePublished - Oct 1 2018

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Health Insurance
Ambulatory Care
Survivors
Neoplasms
Primary Health Care
Physician Assistants
Outpatients
Nurse Practitioners
Survival Rate
Physicians
Health
Vulnerable Populations
Insurance
Health Personnel
Cross-Sectional Studies
Logistic Models
Regression Analysis
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Oncology
  • Oncology(nursing)

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Insurance, chronic health conditions, and utilization of primary and specialty outpatient services : a Childhood Cancer Survivor Study report. / Mueller, Emily L.; Park, Elyse R.; Kirchhoff, Anne C.; Kuhlthau, Karen; Nathan, Paul C.; Perez, Giselle K.; Rabin, Julia; Hutchinson, Raymond; Oeffinger, Kevin C.; Robison, Leslie L.; Armstrong, Gregory; Leisenring, Wendy M.; Donelan, Karen.

In: Journal of Cancer Survivorship, Vol. 12, No. 5, 01.10.2018, p. 639-646.

Research output: Contribution to journalArticle

Mueller, EL, Park, ER, Kirchhoff, AC, Kuhlthau, K, Nathan, PC, Perez, GK, Rabin, J, Hutchinson, R, Oeffinger, KC, Robison, LL, Armstrong, G, Leisenring, WM & Donelan, K 2018, 'Insurance, chronic health conditions, and utilization of primary and specialty outpatient services: a Childhood Cancer Survivor Study report', Journal of Cancer Survivorship, vol. 12, no. 5, pp. 639-646. https://doi.org/10.1007/s11764-018-0700-1
Mueller, Emily L. ; Park, Elyse R. ; Kirchhoff, Anne C. ; Kuhlthau, Karen ; Nathan, Paul C. ; Perez, Giselle K. ; Rabin, Julia ; Hutchinson, Raymond ; Oeffinger, Kevin C. ; Robison, Leslie L. ; Armstrong, Gregory ; Leisenring, Wendy M. ; Donelan, Karen. / Insurance, chronic health conditions, and utilization of primary and specialty outpatient services : a Childhood Cancer Survivor Study report. In: Journal of Cancer Survivorship. 2018 ; Vol. 12, No. 5. pp. 639-646.
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title = "Insurance, chronic health conditions, and utilization of primary and specialty outpatient services: a Childhood Cancer Survivor Study report",
abstract = "Purpose: Survivors of childhood cancer require life-long outpatient healthcare, which may be impacted by health insurance. This study sought to understand survivors’ utilization of outpatient healthcare provider services. Methods: The study examined cross-sectional survey data using an age-stratified sample from the Childhood Cancer Survivor Study of self-reported annual use of outpatient services. Multivariable logistic regression analyses were used to identify risk factors associated with utilization of services. Results: Six hundred ninety-eight survivors were surveyed, median age 36.3 years (range 22.2–62.6), median time from diagnosis 28.8 years (range 23.1–41.7). Almost all (93{\%}) of survivors had at least one outpatient visit during the previous year; 81.3{\%} of these visits were with a primary care providers (PCP), 54.5{\%} were with specialty care physicians, 30.3{\%} were with nurse practitioner/physician’s assistants (NP/PA), and 14.2{\%} were with survivorship clinic providers. Survivors with severe to life-threatening chronic health conditions had greater odds of utilizing a specialty care physician (OR = 5.15, 95{\%} CI 2.89–9.17) or a survivorship clinic (OR = 2.93, 95{\%} CI 1.18–7.26) than those with no chronic health conditions. Having health insurance increased the likelihood of seeking care from NP/PA (private, OR = 2.76, 95{\%} CI 1.37–5.58; public, OR = 2.09, 95{\%} CI 0.85–5.11), PCP (private, OR = 7.82, 95{\%} CI 3.80–13.10; public, OR = 7.24, 95{\%} CI 2.75–19.05), and specialty care (private, OR = 2.96, 95{\%} CI 1.48–5.94; public, OR = 2.93, 95{\%} CI 1.26–6.84) compared to without insurance. Conclusion: Most childhood cancer survivors received outpatient care from a PCP, but a minority received care from a survivorship clinic provider. Having health insurance increased the likelihood of outpatient care. Implications for Cancer Survivors: Targeted interventions in the primary care setting may improve risk-based, survivor-focused care for this vulnerable population.",
author = "Mueller, {Emily L.} and Park, {Elyse R.} and Kirchhoff, {Anne C.} and Karen Kuhlthau and Nathan, {Paul C.} and Perez, {Giselle K.} and Julia Rabin and Raymond Hutchinson and Oeffinger, {Kevin C.} and Robison, {Leslie L.} and Gregory Armstrong and Leisenring, {Wendy M.} and Karen Donelan",
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T1 - Insurance, chronic health conditions, and utilization of primary and specialty outpatient services

T2 - a Childhood Cancer Survivor Study report

AU - Mueller, Emily L.

AU - Park, Elyse R.

AU - Kirchhoff, Anne C.

AU - Kuhlthau, Karen

AU - Nathan, Paul C.

AU - Perez, Giselle K.

AU - Rabin, Julia

AU - Hutchinson, Raymond

AU - Oeffinger, Kevin C.

AU - Robison, Leslie L.

AU - Armstrong, Gregory

AU - Leisenring, Wendy M.

AU - Donelan, Karen

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Purpose: Survivors of childhood cancer require life-long outpatient healthcare, which may be impacted by health insurance. This study sought to understand survivors’ utilization of outpatient healthcare provider services. Methods: The study examined cross-sectional survey data using an age-stratified sample from the Childhood Cancer Survivor Study of self-reported annual use of outpatient services. Multivariable logistic regression analyses were used to identify risk factors associated with utilization of services. Results: Six hundred ninety-eight survivors were surveyed, median age 36.3 years (range 22.2–62.6), median time from diagnosis 28.8 years (range 23.1–41.7). Almost all (93%) of survivors had at least one outpatient visit during the previous year; 81.3% of these visits were with a primary care providers (PCP), 54.5% were with specialty care physicians, 30.3% were with nurse practitioner/physician’s assistants (NP/PA), and 14.2% were with survivorship clinic providers. Survivors with severe to life-threatening chronic health conditions had greater odds of utilizing a specialty care physician (OR = 5.15, 95% CI 2.89–9.17) or a survivorship clinic (OR = 2.93, 95% CI 1.18–7.26) than those with no chronic health conditions. Having health insurance increased the likelihood of seeking care from NP/PA (private, OR = 2.76, 95% CI 1.37–5.58; public, OR = 2.09, 95% CI 0.85–5.11), PCP (private, OR = 7.82, 95% CI 3.80–13.10; public, OR = 7.24, 95% CI 2.75–19.05), and specialty care (private, OR = 2.96, 95% CI 1.48–5.94; public, OR = 2.93, 95% CI 1.26–6.84) compared to without insurance. Conclusion: Most childhood cancer survivors received outpatient care from a PCP, but a minority received care from a survivorship clinic provider. Having health insurance increased the likelihood of outpatient care. Implications for Cancer Survivors: Targeted interventions in the primary care setting may improve risk-based, survivor-focused care for this vulnerable population.

AB - Purpose: Survivors of childhood cancer require life-long outpatient healthcare, which may be impacted by health insurance. This study sought to understand survivors’ utilization of outpatient healthcare provider services. Methods: The study examined cross-sectional survey data using an age-stratified sample from the Childhood Cancer Survivor Study of self-reported annual use of outpatient services. Multivariable logistic regression analyses were used to identify risk factors associated with utilization of services. Results: Six hundred ninety-eight survivors were surveyed, median age 36.3 years (range 22.2–62.6), median time from diagnosis 28.8 years (range 23.1–41.7). Almost all (93%) of survivors had at least one outpatient visit during the previous year; 81.3% of these visits were with a primary care providers (PCP), 54.5% were with specialty care physicians, 30.3% were with nurse practitioner/physician’s assistants (NP/PA), and 14.2% were with survivorship clinic providers. Survivors with severe to life-threatening chronic health conditions had greater odds of utilizing a specialty care physician (OR = 5.15, 95% CI 2.89–9.17) or a survivorship clinic (OR = 2.93, 95% CI 1.18–7.26) than those with no chronic health conditions. Having health insurance increased the likelihood of seeking care from NP/PA (private, OR = 2.76, 95% CI 1.37–5.58; public, OR = 2.09, 95% CI 0.85–5.11), PCP (private, OR = 7.82, 95% CI 3.80–13.10; public, OR = 7.24, 95% CI 2.75–19.05), and specialty care (private, OR = 2.96, 95% CI 1.48–5.94; public, OR = 2.93, 95% CI 1.26–6.84) compared to without insurance. Conclusion: Most childhood cancer survivors received outpatient care from a PCP, but a minority received care from a survivorship clinic provider. Having health insurance increased the likelihood of outpatient care. Implications for Cancer Survivors: Targeted interventions in the primary care setting may improve risk-based, survivor-focused care for this vulnerable population.

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