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Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center
Low-income patients face barriers to palliative care access, which might negatively influence symptom management and advanced care planning. Our aim was to compare time of referral and characteristics (level of symptom distress) among uninsured (indigent), low-insured (Medicaid), and insured patient...
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| Published in: | Journal of pain and symptom management 2018-03, Vol.55 (3), p.973-978 |
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| Main Authors: | , , , , , , , , |
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| cites | cdi_FETCH-LOGICAL-c456t-58232f9f2a3c305042a5c5efb8fdcb2bde2a7f5cb514cdc802557c6d41af9fec3 |
| container_end_page | 978 |
| container_issue | 3 |
| container_start_page | 973 |
| container_title | Journal of pain and symptom management |
| container_volume | 55 |
| creator | Azhar, Ahsan Yennurajalingam, Sriram Ramu, Aashraya Zhang, Haibo Haider, Ali Williams, Janet L. Dibaj, Seyedeh S. Liu, Diane D. Bruera, Eduardo |
| description | Low-income patients face barriers to palliative care access, which might negatively influence symptom management and advanced care planning.
Our aim was to compare time of referral and characteristics (level of symptom distress) among uninsured (indigent), low-insured (Medicaid), and insured patients presenting to our supportive care center (SCC).
We conducted a retrospective review of randomly selected 100 indigent, 100 Medicaid, and 300 insured outpatients referred during the same five-year period. We reviewed demographic and clinical characteristics including date of diagnosis of advanced cancer and of first visit to SCC, symptom assessment (Edmonton Symptom Assessment System), type and dose of opioid medication, number of total outpatient visits, and date of last contact with palliative care team.
Among 482 evaluable patients, indigent, Medicaid, and insured patients, respectively, had mean (SD) ages of 48 (11), 50 (12), and 63 (13) years (P |
| doi_str_mv | 10.1016/j.jpainsymman.2017.10.025 |
| format | article |
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Our aim was to compare time of referral and characteristics (level of symptom distress) among uninsured (indigent), low-insured (Medicaid), and insured patients presenting to our supportive care center (SCC).
We conducted a retrospective review of randomly selected 100 indigent, 100 Medicaid, and 300 insured outpatients referred during the same five-year period. We reviewed demographic and clinical characteristics including date of diagnosis of advanced cancer and of first visit to SCC, symptom assessment (Edmonton Symptom Assessment System), type and dose of opioid medication, number of total outpatient visits, and date of last contact with palliative care team.
Among 482 evaluable patients, indigent, Medicaid, and insured patients, respectively, had mean (SD) ages of 48 (11), 50 (12), and 63 (13) years (P < 0.001); Edmonton Symptom Assessment System pain scores at first visit of 6.7 (2.5), 5.6 (3.2), and 4.9 (3.2) (P < 0.001); nonwhite race in 60%, 49%, and 25% of cases (P < 0.001); unmarried status in 68%, 64%, and 33% of cases (P < 0.001), while 63%, 87%, and 54% of patients (P < 0.001) were on opioids with median number of encounters per month of 0.6, 0.8, and 0.5 (P = 0.001). Median survival (95% CI) from first visit to last contact was 4.6 (2.8–6.2), 5.4 (3.5–7), and 5.6 (4.7–7.3) months (P = 0.036).
Patients with limited or no insurance had significantly higher pain and were more frequently on opioids, younger, nonwhite, and not married. They required higher number of SCC follow-up visits. Insurance status did not affect timing of SCC referral or follow-ups at our cancer center.</description><identifier>ISSN: 0885-3924</identifier><identifier>EISSN: 1873-6513</identifier><identifier>DOI: 10.1016/j.jpainsymman.2017.10.025</identifier><identifier>PMID: 29129738</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Advance directives ; Cancer ; Care plans ; Demography ; Drugs ; Evaluation ; Health care access ; indigent ; Insurance ; Low income groups ; Medicaid ; Medical diagnosis ; Medical referrals ; Opioids ; Outpatients ; Pain ; Palliative care ; palliative care service ; Psychological distress ; Race ; supportive care ; Symptom management ; Teams ; uninsured ; Uninsured people</subject><ispartof>Journal of pain and symptom management, 2018-03, Vol.55 (3), p.973-978</ispartof><rights>2017 American Academy of Hospice and Palliative Medicine</rights><rights>Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Mar 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-58232f9f2a3c305042a5c5efb8fdcb2bde2a7f5cb514cdc802557c6d41af9fec3</citedby><cites>FETCH-LOGICAL-c456t-58232f9f2a3c305042a5c5efb8fdcb2bde2a7f5cb514cdc802557c6d41af9fec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924,30998</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29129738$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Azhar, Ahsan</creatorcontrib><creatorcontrib>Yennurajalingam, Sriram</creatorcontrib><creatorcontrib>Ramu, Aashraya</creatorcontrib><creatorcontrib>Zhang, Haibo</creatorcontrib><creatorcontrib>Haider, Ali</creatorcontrib><creatorcontrib>Williams, Janet L.</creatorcontrib><creatorcontrib>Dibaj, Seyedeh S.</creatorcontrib><creatorcontrib>Liu, Diane D.</creatorcontrib><creatorcontrib>Bruera, Eduardo</creatorcontrib><title>Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center</title><title>Journal of pain and symptom management</title><addtitle>J Pain Symptom Manage</addtitle><description>Low-income patients face barriers to palliative care access, which might negatively influence symptom management and advanced care planning.
Our aim was to compare time of referral and characteristics (level of symptom distress) among uninsured (indigent), low-insured (Medicaid), and insured patients presenting to our supportive care center (SCC).
We conducted a retrospective review of randomly selected 100 indigent, 100 Medicaid, and 300 insured outpatients referred during the same five-year period. We reviewed demographic and clinical characteristics including date of diagnosis of advanced cancer and of first visit to SCC, symptom assessment (Edmonton Symptom Assessment System), type and dose of opioid medication, number of total outpatient visits, and date of last contact with palliative care team.
Among 482 evaluable patients, indigent, Medicaid, and insured patients, respectively, had mean (SD) ages of 48 (11), 50 (12), and 63 (13) years (P < 0.001); Edmonton Symptom Assessment System pain scores at first visit of 6.7 (2.5), 5.6 (3.2), and 4.9 (3.2) (P < 0.001); nonwhite race in 60%, 49%, and 25% of cases (P < 0.001); unmarried status in 68%, 64%, and 33% of cases (P < 0.001), while 63%, 87%, and 54% of patients (P < 0.001) were on opioids with median number of encounters per month of 0.6, 0.8, and 0.5 (P = 0.001). Median survival (95% CI) from first visit to last contact was 4.6 (2.8–6.2), 5.4 (3.5–7), and 5.6 (4.7–7.3) months (P = 0.036).
Patients with limited or no insurance had significantly higher pain and were more frequently on opioids, younger, nonwhite, and not married. They required higher number of SCC follow-up visits. Insurance status did not affect timing of SCC referral or follow-ups at our cancer center.</description><subject>Advance directives</subject><subject>Cancer</subject><subject>Care plans</subject><subject>Demography</subject><subject>Drugs</subject><subject>Evaluation</subject><subject>Health care access</subject><subject>indigent</subject><subject>Insurance</subject><subject>Low income groups</subject><subject>Medicaid</subject><subject>Medical diagnosis</subject><subject>Medical referrals</subject><subject>Opioids</subject><subject>Outpatients</subject><subject>Pain</subject><subject>Palliative care</subject><subject>palliative care service</subject><subject>Psychological distress</subject><subject>Race</subject><subject>supportive care</subject><subject>Symptom management</subject><subject>Teams</subject><subject>uninsured</subject><subject>Uninsured people</subject><issn>0885-3924</issn><issn>1873-6513</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNqNkc1u1TAQhS0EoreFV0BGbFiQi3_i_CxRVGiloiJo15bjTLiObpxgO5X6QjwnE-WCECs2tnXONzPWHEJec7bnjBfvh_0wG-fj4zgavxeMl6jvmVBPyI5XpcwKxeVTsmNVpTJZi_yMnMc4MMaULORzciZqLupSVjvy886Nzn-nU0-_Qg8hmCM1vqPNwQRjEwQXk7Nx9e89jlwCdO_oZ-icNQ5fK3u9yfSLSQ58iqdOqKSJpgPQ2yXNm0e_LfM8heQegDYm4IEiBGoSNbSZxjnAAXzcbG_R2YAX5FlvjhFenu4Lcv_x8q65ym5uP103H24ym6siZaoSUvR1L4y0kimWC6Osgr6t-s62ou1AmLJXtlU8t52tcGWqtEWXc4NVYOUFebv1ncP0Y4GY9OiihePReJiWqHldyLzIeakQffMPOkxL8Pg7LVjOSpXjgpGqN8qGKcYAvZ6DG0141JzpNUw96L_C1GuYq4U_w9pXpwlLO0L3p_J3egg0GwC4kgcHQUeLW7aYTgCbdDe5_xjzCwxguZY</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Azhar, Ahsan</creator><creator>Yennurajalingam, Sriram</creator><creator>Ramu, Aashraya</creator><creator>Zhang, Haibo</creator><creator>Haider, Ali</creator><creator>Williams, Janet L.</creator><creator>Dibaj, Seyedeh S.</creator><creator>Liu, Diane D.</creator><creator>Bruera, Eduardo</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201803</creationdate><title>Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center</title><author>Azhar, Ahsan ; Yennurajalingam, Sriram ; Ramu, Aashraya ; Zhang, Haibo ; Haider, Ali ; Williams, Janet L. ; Dibaj, Seyedeh S. ; Liu, Diane D. ; Bruera, Eduardo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-58232f9f2a3c305042a5c5efb8fdcb2bde2a7f5cb514cdc802557c6d41af9fec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Advance directives</topic><topic>Cancer</topic><topic>Care plans</topic><topic>Demography</topic><topic>Drugs</topic><topic>Evaluation</topic><topic>Health care access</topic><topic>indigent</topic><topic>Insurance</topic><topic>Low income groups</topic><topic>Medicaid</topic><topic>Medical diagnosis</topic><topic>Medical referrals</topic><topic>Opioids</topic><topic>Outpatients</topic><topic>Pain</topic><topic>Palliative care</topic><topic>palliative care service</topic><topic>Psychological distress</topic><topic>Race</topic><topic>supportive care</topic><topic>Symptom management</topic><topic>Teams</topic><topic>uninsured</topic><topic>Uninsured people</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Azhar, Ahsan</creatorcontrib><creatorcontrib>Yennurajalingam, Sriram</creatorcontrib><creatorcontrib>Ramu, Aashraya</creatorcontrib><creatorcontrib>Zhang, Haibo</creatorcontrib><creatorcontrib>Haider, Ali</creatorcontrib><creatorcontrib>Williams, Janet L.</creatorcontrib><creatorcontrib>Dibaj, Seyedeh S.</creatorcontrib><creatorcontrib>Liu, Diane D.</creatorcontrib><creatorcontrib>Bruera, Eduardo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pain and symptom management</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Azhar, Ahsan</au><au>Yennurajalingam, Sriram</au><au>Ramu, Aashraya</au><au>Zhang, Haibo</au><au>Haider, Ali</au><au>Williams, Janet L.</au><au>Dibaj, Seyedeh S.</au><au>Liu, Diane D.</au><au>Bruera, Eduardo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center</atitle><jtitle>Journal of pain and symptom management</jtitle><addtitle>J Pain Symptom Manage</addtitle><date>2018-03</date><risdate>2018</risdate><volume>55</volume><issue>3</issue><spage>973</spage><epage>978</epage><pages>973-978</pages><issn>0885-3924</issn><eissn>1873-6513</eissn><abstract>Low-income patients face barriers to palliative care access, which might negatively influence symptom management and advanced care planning.
Our aim was to compare time of referral and characteristics (level of symptom distress) among uninsured (indigent), low-insured (Medicaid), and insured patients presenting to our supportive care center (SCC).
We conducted a retrospective review of randomly selected 100 indigent, 100 Medicaid, and 300 insured outpatients referred during the same five-year period. We reviewed demographic and clinical characteristics including date of diagnosis of advanced cancer and of first visit to SCC, symptom assessment (Edmonton Symptom Assessment System), type and dose of opioid medication, number of total outpatient visits, and date of last contact with palliative care team.
Among 482 evaluable patients, indigent, Medicaid, and insured patients, respectively, had mean (SD) ages of 48 (11), 50 (12), and 63 (13) years (P < 0.001); Edmonton Symptom Assessment System pain scores at first visit of 6.7 (2.5), 5.6 (3.2), and 4.9 (3.2) (P < 0.001); nonwhite race in 60%, 49%, and 25% of cases (P < 0.001); unmarried status in 68%, 64%, and 33% of cases (P < 0.001), while 63%, 87%, and 54% of patients (P < 0.001) were on opioids with median number of encounters per month of 0.6, 0.8, and 0.5 (P = 0.001). Median survival (95% CI) from first visit to last contact was 4.6 (2.8–6.2), 5.4 (3.5–7), and 5.6 (4.7–7.3) months (P = 0.036).
Patients with limited or no insurance had significantly higher pain and were more frequently on opioids, younger, nonwhite, and not married. They required higher number of SCC follow-up visits. Insurance status did not affect timing of SCC referral or follow-ups at our cancer center.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29129738</pmid><doi>10.1016/j.jpainsymman.2017.10.025</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0885-3924 |
| ispartof | Journal of pain and symptom management, 2018-03, Vol.55 (3), p.973-978 |
| issn | 0885-3924 1873-6513 |
| language | eng |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); ScienceDirect Freedom Collection 2022-2024 |
| subjects | Advance directives Cancer Care plans Demography Drugs Evaluation Health care access indigent Insurance Low income groups Medicaid Medical diagnosis Medical referrals Opioids Outpatients Pain Palliative care palliative care service Psychological distress Race supportive care Symptom management Teams uninsured Uninsured people |
| title | Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center |
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