부산대학교 도서관

Background: Medicare-subsidised Team Care Arrangements (TCAs) support Australian general practitioners to implement shared care between collaborating health professionals for patients with chronic medical conditions and complex needs. We assessed the prevalence of TCAs, factors associated with TCA uptake and visits to TCA-subsidised allied health practitioners, for adults newly diagnosed with cancer in New South Wales, Australia. Methods: We carried out a retrospective individual patient data linkage study with 13 951 45 and Up Study participants diagnosed with incident cancer during 2006–16. We used a proportional hazards model to estimate the factors associated with receipt of a TCA after cancer diagnosis. Results: In total, 6630 patients had a TCA plan initiated (47.5%). A TCA was more likely for patients aged ≥65 years, those with higher service utilisation 4–15 months prior to cancer diagnosis, a higher number of comorbidities, lower self-rated overall health status, living in areas of greater socio-economic disadvantage, lower educational attainment and those with no private health insurance. A total of 4084 (61.6%) patients with a TCA had at least one TCA-subsidised allied health visit within 24 months of the TCA. Conclusions: TCAs appear to be well targeted at cancer patients with chronic health conditions and lower socioeconomic status. Nevertheless, not all patients with a TCA subsequently attended a TCA-subsidised allied healthcare professional. This suggests either a misunderstanding of the plan, the receipt of allied health via other public schemes, a low prioritisation of the plan compared to other health care, or suboptimal availability of these services. Medicare-subsidised Team Care Arrangements (TCAs), designed to coordinate care for people with long-term chronic or terminal conditions requiring treatment from a multidisciplinary team, have not been evaluated for adults newly diagnosed with cancer. Of those, 47.5% have a TCA initiated, but not all take up community-based TCA-subsidised allied health care. Prior poor health and lower socioeconomic status made TCAs more likely. TCAs appear well aligned with need. Apparent incomplete uptake of TCA-subsidised allied health services suggests suboptimal utilisation of this plan. Investigation of the healthcare trajectories of specific patient subgroups may help identify barriers. [ABSTRACT FROM AUTHOR]