The Independent Clinical Oncology Network (ICON) has signed a memorandum of understanding with the Independent Practitioners Association Foundation (IPAF) that will see family practitioners playing a greater role in cancer care in SA.
This important development is aimed at addressing the current fragmentation of cancer care and changing the focus from terminal to preventative treatment, a patient-centric approach that will lead to early detection and better end of life treatment.
Throughout the spectrum between detection and end of life care, the GP will play an integral role, said health management consultant, Dr Martin de Villiers.
ICON is negotiating with medical schemes to introduce front-end benefits including full body screening to pick up cancers early and preventing expensive downstream costs.
“For 20 years we have been dealing with fragmented care of cancer patients. The patient is referred to the specialists and there is no referral back to the GPs. This results in comorbidities not being purposefully managed, so that a patient may die of, say, a diabetic crisis while his cancer is being cured,” Dr de Villiers explained.
There is also a major problem at end of life when palliative care should kick in, he said, with oncologists continuing treatment even when they realise that this would be futile, resulting in patients who would prefer to die at home staying in hospital, receiving high intensive care and not receiving the quality care they need in their own surroundings.
Dr de Villiers said the current managed care cancer model, being encounter management, with its focus on return on investment and trying to save costs, has not worked. “This is ‘first generation’ cancer care. It is a model that did not lower costs and improved access and quality. The ICON model is fourth generation, focusing on clinical integration, very similar to that used in the patient-centred medical home and accountable care organisations, with funders and doctors aligning for a better impact on the patient.
“What we want to see is an integrated continuum for oncology. This involves negotiating with schemes for screening benefits. We want treating oncologists to interact with GPs and make sure they are informed on what’s happening so that the patient can be managed at a community level.”
ICON is negotiating benefits for GPs to be able to screen patients and provide benefits that will include referral to an oncology social worker to address the psychosocial needs of the patient and his/her family.
“We want GPs to be informed, so that they will diagnose and refer early,” said Dr de Villiers. From then on treatment will involve a multidisciplinary team, with the oncologist as team leader. If the patient gets to the stage where any further interactive treatment would be futile, then it is time to have the ‘difficult conversation’.
The family practitioner then becomes the leader of the team, involving the social worker to assess whether the patient can be managed at home. Interaction with the specialist continues because sometimes even for symptomatic treatment low-dose radiation or chemotherapy is needed.
ICON commenced with a pilot through 2012 with Bankmed and Fedhealth and although uptake is not yet what it should be, Dr de Villiers believes there is a definite move towards front-end, as opposed to back-end treatment.
“IPAF and ICON have firmly placed the prevention and early detection of cancer as well as the care of patients suffering with the disease, back into the hands of the GPs and multidisciplinary teams,” said IPAF COO, Dr Tony Behrman. “IPAF looks forward to doing the same for other prescribed minimum benefit conditions like hypertension, asthma and epilepsy.
To go to the IPAF website, click here