Kelly Filchner Notes Barriers Preventing Integration of Primary Care Providers Into Oncology Care

April 30, 2020

Innovations to promote communication between primary care providers, oncologists are vital to delineate distinct roles in oncology patient management, said Kelly Filchner, MSN, director at Fox Chase Cancer Center Partners.

Innovations to promote communication between primary care providers, oncologists are vital to delineate distinct roles in oncology patient management, said Kelly Filchner, MSN, director at Fox Chase Cancer Center Partners.

Transcript

What are the best practices for quantifying and communicating the value of survivorship care offered by primary care physicians (PCPs)?

I think first of all, the PCPs have core competencies and education that they probably need. They want to be part of the care team. They're very comfortable with preventative care and lifestyle, like helping people with obesity and exercise, but they might not be quite as comfortable with the other portions of survivorship, such as the long term surveillance and possible side effects. So, those are the things we have to look at when we're developing programs and trying to get things started with PCPs.

What are the most prominent barriers preventing successful integration of primary care providers into oncology patient management?

Well, start with electronic medical records (EMRs)—they're probably a help and a hindrance. So, it's great that we have them, but they're not perfect, and you might have a patient that sees physicians in multiple systems. So, then you have to make sure those EMRs talk to each other. It's a good way of making sure communication occurs between the physicians. The other part of that is that if we develop survivorship care plans, and they're in the electronic medical record, where do they live? So, I did a random search where I work on where we keep those survivorship care plans, and I kind of found them in a couple different places. Even though the PCPs are in our system, they can actually enter the records because they're part of the system and they can look for those care plans. I don't know if they'd know where to look, because we haven't really told them. So, I think that's 1 of the big barriers there.

Another one is confusion about who's supposed to do what. So, what is the PCP supposed to take care of versus what is the oncologist supposed to take care of. So, there's a lot of research out there about different models of care and who should lead survivorship. Again, I'm going to go back to the United Kingdom, they've done a lot of work with self-management of patients—so they risk-stratify the patients to see which ones can manage their follow up and making sure they get to the resources they need on their own, versus a patient who needs a little bit more provider support. They've implemented this in many of their, they call them trusts in the United Kingdom, and it's been very successful.

So, we need to be a little bit more innovative. I know it's not going to be easy because we have so many different types of healthcare systems here in the US and all different kinds of insurances and things like that—just makes things a little bit more tricky. I think policy and the payers are another big part of it because we need to have support to be able to give the survivorship care that we should be giving, and some of that might be, do we need to carve out special codes or whatever for those types of visits so that the patients can get what they need.