Guidelines recommend long term follow-up for women after breast cancer treatment . In Australia approximately 15,740 new breast cancer cases were diagnosed in 2015 and five year relative survival is 90% . The joint participation of specialists and primary care physicians in shared care for early breast cancer (EBC) can optimise the use of the specialist workforce and deliver best practice and sustainable follow-up care.
To evaluate the extent to which shared follow-up care for EBC supports best practice care and to identify key enablers and barriers to its uptake.
Following a demonstration of shared follow-up care for women with EBC (2009-2011), an evaluation to assess the extent to which the model supports the delivery of best practice follow-up care was conducted (2013-15). Follow-up appointments involving 505 patients across five sites were documented over a two year period to assess the extent to which best-practice guidelines were adhered to within a shared follow-up care model. A qualitative evaluation of patient and health provider experiences was also undertaken.
The majority of appointments included completion of follow-up actions in accordance with guidelines. Compared to specialists, a significantly higher proportion of general practitioners addressed psychosocial issues, secondary prevention behaviours, menopausal status and other health conditions and reviewed family history. Mammograms were provided to 73% of patients at least annually, in accordance with guidelines. Shared follow-up care was also shown to improve patient satisfaction. Established partnerships between specialist and primary care was identified as a key enabler of shared follow-up care. Timely and effective communication between health care providers was critical to the successful delivery of this model of care.
The evaluation demonstrated that partnerships between specialists and general practitioners can support the best-practice provision of shared follow-up care for early breast cancer.