Patterns of primary health care service use of Indigenous Australians diagnosed with cancer
The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians.
A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010–2016 were abstracted from patient’s medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator.
A total of 138 patients’ records were audited. During 12 months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61–2.17; IRR = 1.79, 95%CI 1.45–2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts.
The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.
KeywordsCancer care Primary care General practitioners (GPs) Indigenous Australians
The authors would like to thank Aboriginal Community Controlled Health Organizations and primary health care staff at participating centers for their support for this study.
PCV, RB, GG, and AdW contributed to the conception and design of the study. PCV performed the data analysis and takes responsibility for the integrity and the accuracy of the data. PCV drafted the report. All authors contributed the interpretation of data, revising draft critically for important intellectual content, and approved the final version.
This work was supported by the National Health and Medical Research Council (no. 1044433). PCV was supported by the National Health and Medical Research Council (Career Development Fellowship no. 1083090). ADW was sup-ported by an Australian Postgraduate Award Scholarship from Charles Darwin University and a top up scholarship from Menzies School of Health Research. GG was supported by a National Health and Medical Research Council Early Career Research Fellowship (no. 1105399). This study was undertaken under the auspices of the Centre of Research Excellence in Discovering Indigenous Strategies to Improve Cancer Outcomes Via Engagement, Research Translation and Training (DISCOVER-TT CRE, funded by the National Health and Medical Research Council no. 1041111) and the Strategic Research Partnership to improve Cancer control for Indigenous Australians (STREP Ca-CIndA, funded through Cancer Council NSW (SRP 13-01) with supplementary funding from Cancer Council WA). The views expressed in this publication are those of the authors and do not necessarily reflect the views of the funding agencies.
Compliance with ethical standards
Conflict of interest
There is no conflict of interest. Authors have no financial relationship with the organizations that sponsored the research. PCV had full control of all primary data and agree to allow the journal to review our data if requested.
Ethics approvals for the study were obtained from the Human Research Ethics Committees of the Darling Downs Hospital and Health Service, Menzies School of Research, and QIMR Berghofer Medical Research Institute.
- 1.Cancer Research UK. Cancer survival statistics 2011. Available from: http://www.cancerresearchuk.org/health-professional/cancer-statistics/survival/all-cancerscombined. Accessed 1 Sept 2018
- 2.Australian Institute of Health and Wellfare (2017) Cancer in Australia. In: Australian Bureau of Statistics (ed) Cancer series no. 101. Cat. no. CAN 100. AIHW, CanberraGoogle Scholar
- 9.Adam R, Watson E (2018) The role of primary care in supporting patients living with and beyond cancer. Curr Opin Support Palliat Care 12(3):261–267Google Scholar
- 10.Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C (2015) The expanding role of primary care in cancer control. Lancet Oncol 16(12):1231–1272CrossRefGoogle Scholar
- 13.Whop LJ et al (2012) Cancer support services--are they appropriate and accessible for indigenous cancer patients in Queensland, Australia? Rural Remote Health 12:2018Google Scholar
- 14.National Rural Health Alliance (2016) The health of people living in remote Australia. [25 Jun 2018]; Available from: http://www.ruralhealth.org.au/factsheets/thumbs
- 21.Australian Institute of Health and Welfare (AIHW) and Cancer Australia (2018) Cancer in Aboriginal & Torres Strait Islander people of Australia. AIHW, CanberraGoogle Scholar
- 22.Australian Institute of Health and Welfare (AIHW) (2015) The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. AIHW, CanberraGoogle Scholar
- 23.Chong A, Roder D (2010) Exploring differences in survival from cancer among indigenous and non-indigenous Australians: implications for health service delivery and research. Asian Pac J Cancer Prev 11(4):953–961Google Scholar
- 24.Condon JR et al (2004) Long-term trends in cancer mortality for indigenous Australians in the Northern Territory. Med J Aust 180(10):504–507Google Scholar
- 28.Australian Bureau of Statistics (ABS) (2014) Estimates and projections, Aboriginal and Torres Strait Islander Australians. ABS, CanberraGoogle Scholar
- 29.Panaretto KS, Gardner KL, Button S, Carson A, Schibasaki R, Wason G, Baker D, Mein J, Dellit A, Lewis D, Wenitong M, Ring I (2013) Prevention and management of chronic disease in aboriginal and islander community controlled health Services in Queensland: a quality improvement study assessing change in selected clinical performance indicators over time in a cohort of services. BMJ Open 3(4):e002083CrossRefGoogle Scholar
- 31.de Witt A, Cunningham FC, Bailie R, Bernardes CM, Matthews V, Arley B, Meiklejohn JA, Garvey G, Adams J, Martin JH, Walpole ET, Williamson D, Valery PC (2017) Identification of Australian aboriginal and Torres Strait islander Cancer patients in the primary health care setting. Front Public Health 5:199CrossRefGoogle Scholar
- 33.Young JL et al (2001) Summary Staging Manual 2000: Codes and Coding Instructions. National Cancer Institute, BethesdaGoogle Scholar
- 35.Holmberg L (2005) The role of the primary-care physician in oncology care. Primary healthcare and specialist cancer services. Lancet Oncol 6(2):121–122Google Scholar
- 36.Deeble J (2009) Assessing the health service use of aboriginal and Torres Strait islander peoples. Department of Health and Ageing, Australian Government Canberra. Available from: https://www.westerndesertdialysis.com/archives/references/20090600%20John%20Deeble%20Indigenous%20paper.pdf. Accessed 1 Sept 2018
- 37.Australian Institute of Health and Welfare (AIHW) (2018) Mental health services in Australia [7 Jul 2018]. Available from: https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/reportcontents/summary-of-mental-health-services-in-australia. Accessed 1 Sept 2018
- 38.Brennan M et al (2011) Follow up after breast cancer -- views of Australian women. Aust Fam Physician 40(5):311–316Google Scholar
- 41.Matthews V et al (2018) Submission to the Senate Inquiry, “Accessibility and quality of mental health services in rural and remote Australia” On behalf of the Centre for Research Excellence in integrated quality improvementGoogle Scholar
- 45.Campbell MA et al (2017) Contribution of aboriginal community-controlled health services to improving aboriginal health: an evidence review. Aust Health Rev 42(2):218–226Google Scholar