Utilisation of Chronic Disease and Mental Health Management Services and Cardioprotective Medication Prescriptions in Primary Care for Patients With Cardiovascular Diseases and Cancer: A Cross-Sectional Study.

Tu, Q; Hyun, K; Hafiz, N; Knight, A; Hespe, C; Chow, CK; Briffa, T; Gallagher, R; Reid, CM; Hare, DL; Zwar, N; Woodward, M; Jan, S; Atkins, ER; Laba, T-L; Halcomb, E; Hollings, M; Singleton, A; Usherwood, T; Redfern, J

Utilisation of Chronic Disease and Mental Health Management Services and Cardioprotective Medication Prescriptions in Primary Care for Patients With Cardiovascular Diseases and Cancer: A Cross-Sectional Study.

Tu, Q Hyun, K Hafiz, N Knight, A Hespe, C Chow, CK Briffa, T Gallagher, R Reid, CM Hare, DL Zwar, N Woodward, M Jan, S Atkins, ER Laba, T-L Halcomb, E Hollings, M Singleton, A Usherwood, T Redfern, J

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Publisher:: ELSEVIER SCIENCE INC
Publication Type:: Journal Article
Citation:: Heart Lung Circ, 2024, 33, (5), pp. 738-746
Issue Date:: 2024-05

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Field	Value	Language
dc.contributor.author	Tu, Q
dc.contributor.author	Hyun, K
dc.contributor.author	Hafiz, N
dc.contributor.author	Knight, A
dc.contributor.author	Hespe, C
dc.contributor.author	Chow, CK
dc.contributor.author	Briffa, T
dc.contributor.author	Gallagher, R
dc.contributor.author	Reid, CM
dc.contributor.author	Hare, DL
dc.contributor.author	Zwar, N
dc.contributor.author	Woodward, M
dc.contributor.author	Jan, S
dc.contributor.author	Atkins, ER
dc.contributor.author	Laba, T-L
dc.contributor.author	Halcomb, E
dc.contributor.author	Hollings, M
dc.contributor.author	Singleton, A
dc.contributor.author	Usherwood, T
dc.contributor.author	Redfern, J
dc.date.accessioned	2024-10-21T03:36:08Z
dc.date.available	2024-01-23
dc.date.available	2024-10-21T03:36:08Z
dc.date.issued	2024-05
dc.identifier.citation	Heart Lung Circ, 2024, 33, (5), pp. 738-746
dc.identifier.issn	1443-9506
dc.identifier.issn	1444-2892
dc.identifier.uri	http://hdl.handle.net/10453/181499
dc.description.abstract	BACKGROUND: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors. Mental health is considered an important risk factor affecting the treatment of cardiovascular disease. However, little is known about the use of secondary prevention strategies for CVD in patients with both cancer and CVD. This study aimed to compare the utilisation of primary care chronic disease management plans, mental health care and guideline-indicated cardioprotective medications among CVD patients with and without cancer. METHODS: Retrospective cross-sectional study utilising clinical data of patients with CVD from 50 Australian primary care practices. Outcomes included the use of chronic disease management plans, mental health care, guideline-indicated cardioprotective medications and influenza vaccination. Logistic regression, accounting for demographic and clinical covariates and clustering effects by practices, was used to compare the two groups. RESULTS: Of the 15,040 patients with CVD, 1,486 patients (9.9%) concurrently had cancer. Patients with cancer, compared to those without, were older (77.6 vs 71.8 years, p<0.001), more likely to drink alcohol (62.6% vs 55.7%, p<0.001), have lower systolic (130.3±17.8 vs 132.5±21.1 mmHg, p<0.001) and diastolic (72.2±11 vs 75.3±34 mmHg, p<0.001) blood pressure. Although suboptimal for both groups, patients with cancer were significantly more likely to have general practice management plans (GPMPs) (51.4% vs 43.2%, p<0.001), coordination of team care arrangements (TCAs) (46.2% vs 37.0%, p<0.001), have a review of either GPMP or TCA (42.8% vs 34.7%, p<0.001), have a mental health treatment consultation (15.4% vs 10.5%, p=0.004) and be prescribed blood pressure-lowering medications (70.1% vs 66.0%, p=0.002). However, there were no statistical differences in the prescription of lipid-lowering or antiplatelet medications. After adjustments for covariates and multiple testing, patients with cancer did not show a difference in GPMPs, TCAs, and a review of either, but were more likely to receive mental health treatment consultations than those without cancer (odds ratio 1.76; 95% confidence interval 1.42-2.19). CONCLUSIONS: Less than half of patients with CVD had a GPMP, TCA or review of either. Although those patients with cancer were more likely to receive these interventions, still around half the patients did not. Medicare-funded GPMPs, TCAs and a review of either GPMP or TCA were underutilised, and future studies should seek to identify ways of improving access to these services.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	ELSEVIER SCIENCE INC
dc.relation.ispartof	Heart Lung Circ
dc.relation.isbasedon	10.1016/j.hlc.2024.01.030
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1102 Cardiorespiratory Medicine and Haematology, 1117 Public Health and Health Services
dc.subject.classification	Cardiovascular System & Hematology
dc.subject.classification	3201 Cardiovascular medicine and haematology
dc.subject.classification	4203 Health services and systems
dc.subject.classification	4206 Public health
dc.subject.mesh	Humans
dc.subject.mesh	Cross-Sectional Studies
dc.subject.mesh	Male
dc.subject.mesh	Neoplasms
dc.subject.mesh	Female
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Cardiovascular Diseases
dc.subject.mesh	Aged
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Chronic Disease
dc.subject.mesh	Australia
dc.subject.mesh	Mental Health Services
dc.subject.mesh	Cardiotonic Agents
dc.subject.mesh	Middle Aged
dc.subject.mesh	Disease Management
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Cardiovascular Diseases
dc.subject.mesh	Chronic Disease
dc.subject.mesh	Cardiotonic Agents
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Cross-Sectional Studies
dc.subject.mesh	Mental Health Services
dc.subject.mesh	Aged
dc.subject.mesh	Middle Aged
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Disease Management
dc.subject.mesh	Australia
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Humans
dc.subject.mesh	Cross-Sectional Studies
dc.subject.mesh	Male
dc.subject.mesh	Neoplasms
dc.subject.mesh	Female
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Cardiovascular Diseases
dc.subject.mesh	Aged
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Chronic Disease
dc.subject.mesh	Australia
dc.subject.mesh	Mental Health Services
dc.subject.mesh	Cardiotonic Agents
dc.subject.mesh	Middle Aged
dc.subject.mesh	Disease Management
dc.title	Utilisation of Chronic Disease and Mental Health Management Services and Cardioprotective Medication Prescriptions in Primary Care for Patients With Cardiovascular Diseases and Cancer: A Cross-Sectional Study.
dc.type	Journal Article
utslib.citation.volume	33
utslib.location.activity	Australia
utslib.for	1102 Cardiorespiratory Medicine and Haematology
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Centre for Health Economics Research and Evaluation (CHERE)
pubs.organisational-group	University of Technology Sydney/UTS Groups/Centre for Health Economics Research and Evaluation (CHERE)/Centre for Health Economics Research and Evaluation (CHERE) Associate Member
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2024-10-21T03:36:04Z
pubs.issue	5
pubs.publication-status	Published
pubs.volume	33
utslib.citation.issue	5

Abstract:

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors. Mental health is considered an important risk factor affecting the treatment of cardiovascular disease. However, little is known about the use of secondary prevention strategies for CVD in patients with both cancer and CVD. This study aimed to compare the utilisation of primary care chronic disease management plans, mental health care and guideline-indicated cardioprotective medications among CVD patients with and without cancer. METHODS: Retrospective cross-sectional study utilising clinical data of patients with CVD from 50 Australian primary care practices. Outcomes included the use of chronic disease management plans, mental health care, guideline-indicated cardioprotective medications and influenza vaccination. Logistic regression, accounting for demographic and clinical covariates and clustering effects by practices, was used to compare the two groups. RESULTS: Of the 15,040 patients with CVD, 1,486 patients (9.9%) concurrently had cancer. Patients with cancer, compared to those without, were older (77.6 vs 71.8 years, p<0.001), more likely to drink alcohol (62.6% vs 55.7%, p<0.001), have lower systolic (130.3±17.8 vs 132.5±21.1 mmHg, p<0.001) and diastolic (72.2±11 vs 75.3±34 mmHg, p<0.001) blood pressure. Although suboptimal for both groups, patients with cancer were significantly more likely to have general practice management plans (GPMPs) (51.4% vs 43.2%, p<0.001), coordination of team care arrangements (TCAs) (46.2% vs 37.0%, p<0.001), have a review of either GPMP or TCA (42.8% vs 34.7%, p<0.001), have a mental health treatment consultation (15.4% vs 10.5%, p=0.004) and be prescribed blood pressure-lowering medications (70.1% vs 66.0%, p=0.002). However, there were no statistical differences in the prescription of lipid-lowering or antiplatelet medications. After adjustments for covariates and multiple testing, patients with cancer did not show a difference in GPMPs, TCAs, and a review of either, but were more likely to receive mental health treatment consultations than those without cancer (odds ratio 1.76; 95% confidence interval 1.42-2.19). CONCLUSIONS: Less than half of patients with CVD had a GPMP, TCA or review of either. Although those patients with cancer were more likely to receive these interventions, still around half the patients did not. Medicare-funded GPMPs, TCAs and a review of either GPMP or TCA were underutilised, and future studies should seek to identify ways of improving access to these services.

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http://hdl.handle.net/10453/181499