TABLE 4-2 Distribution of Adult Ambulatory Cancer Care Visits, by Site of Visit, Physician Specialty, and Clinic Type, United States, 2001–2002a

Visit Characteristic

Number/Percentage

Annual number of visits (in 1,000s)

20,574

Site of visits (%)

Physician’s office

89

Hospital outpatient department

11

Physician office visitsb (%)

Oncology

18

Primary care

32

General surgery

10

Specialty surgery

3

Dermatology

7

Urology

14

Other medical specialty

15

Hospital outpatient departmentc (%)

General medicine

78

Surgery

14

Other

8

aAdults were categorized as being aged 25 and older. Visits for non-melanoma skin cancer were excluded.

bRadiologists were excluded from the sample of office-based physicians.

cClinics providing chemotherapy, radiotherapy, physical medicine, and rehabilitation were excluded from the sample of hospital outpatient departments.

SOURCE: Committee staff analyses of the 2001 and 2002 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. See Appendix 4B for details on analyses.

specialist who participates in shared care is to provide guidance and treatment in the area of expertise, to keep the primary care clinician informed of the treatment plan, and to return the patient to the primary care provider for implementation of the treatment plan and for care of other health needs. This model is applicable for many conditions, including when primary care providers share care for the management of chronic heart failure (working with cardiologists), multiple sclerosis (working with neurologists), bipolar disorder (working with psychiatrists), and chronic renal failure (working with nephrologists).

The shared care model depends on the specialist and generalist having a common understanding of expected components of care and respective roles, and works best when providers communicate clearly with each other. Shared care may not be fully understood or practiced. Specialists may



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