51
|
Effect of reminders mailed to general practitioners on colorectal cancer screening adherence: a cluster-randomized trial. Eur J Cancer Prev 2018; 25:380-7. [PMID: 26340058 DOI: 10.1097/cej.0000000000000200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reminders have been used in various settings, but failed to produce convincing evidence of benefits on patient adherence to colorectal cancer (CRC) screening. The aim of this study was to assess the effectiveness of sending general practitioners (GPs) printed reminders about CRC screening. We conducted a cluster-randomized controlled trial involving 144 GPs in the Val-de-Marne district (France), who provided care for any reason to 20 778 patients eligible for CRC screening between June 2010 and November 2011. Data were collected from the main statutory health-insurance programme and local cancer screening agency. GPs were randomly assigned in a 1 : 1 proportion to the intervention or the control group. Every 4 months, intervention-group GPs received a computer-generated printed list of patients who had not performed scheduled faecal occult blood test (FOBT) screening. The primary outcome was patient adherence to FOBT screening or exclusion from CRC screening for medical reasons. The screening adherence rate was 31.2% [95% confidence interval (CI) 30.3-32.1] in the control group and 32.9% (95% CI 32.0-33.8) in the intervention group [crude relative risk, 1.05 (95% CI 1.01-1.09), P<0.01]. This rate was not significantly different between groups by multilevel modelling accounting for clustering and confounding variables [adjusted relative risk, 1.07 (95% CI 0.95-1.20), P=0.27]. Computer-generated printed reminders sent to GPs did not significantly improve patient adherence to organized CRC screening by the FOBT.
Collapse
|
52
|
Lee S, Miller A. Factors influencing participation in fecal occult blood testing to screen for colorectal cancer in Australia: a scoping review protocol. ACTA ACUST UNITED AC 2018; 16:57-62. [PMID: 29324557 DOI: 10.11124/jbisrir-2017-003392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
REVIEW QUESTION The objective of this scoping review is to examine and map the evidence on the range of factors influencing a person's decision to screen or not screen for colorectal cancer using a fecal occult blood test (FOBT) in Australia, with the view to identifying gaps in the research and informing appropriate questions for future systematic reviews.The question of this review is: what evidence is available around the barriers and facilitators that influence an individual's decision to screen or not screen for colorectal cancer using a fecal occult blood test in Australia?
Collapse
Affiliation(s)
- Simone Lee
- Centre for Rural Health, Faculty of Health, University of Tasmania, Launceston, Australia
| | - Andrea Miller
- School of Health Sciences, Faculty of Health, University of Tasmania, Launceston, Australia
| |
Collapse
|
53
|
Chan EK, Wilson C, Tyldesley S, Olivotto IA, Lai A, Sam J, Harry R, Nichol A. Signed family physician reminder letters to women overdue for screening mammography: A randomized clinical trial. J Med Screen 2017; 25:149-154. [DOI: 10.1177/0969141317719921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To determine whether signed family physician reminder letters to women overdue for screening mammography prompts rescreening. Methods A randomized double-blind trial conducted in 2013 among women aged 51–73 and overdue for screening by 6–24 months. The study was carried out by the publicly funded British Columbia Cancer Agency Screening Mammography Program, which routinely sends standard reminder postcards to women who are due for mammography. Participating family physicians signed letters for the overdue women in their practices. The overdue women were mailed either the signed reminder letter and the standard reminder postcard, or the standard reminder postcard alone. The primary endpoint was the proportion of overdue women that attended a screening mammogram appointment within six months of mailing the study letters. The analysis was by intention to treat. Results In total, 822 family physicians participated and 5638 women were randomized. Mammography attendance by six months after mailing the reminders was 34.4% (947/2749) for women in the signed family physician letter arm, compared with 24.0% (660/2749) for women in the control arm (p < 0.0001). Adjusting for age, number of previous screening mammograms, and months overdue, women in the signed letter arm were significantly more likely to return for screening than women in the control arm (RR 1.41; 95% confidence interval: 1.30–1.54). Conclusion A signed family physician reminder letter improved mammography attendance for women who were overdue for screening mammography.
Collapse
Affiliation(s)
| | - Christine Wilson
- BC Cancer Agency, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Scott Tyldesley
- BC Cancer Agency, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Ivo A Olivotto
- University of Calgary and Tom Baker Cancer Centre, Calgary, Canada
| | - Anky Lai
- BC Cancer Agency, Vancouver, Canada
| | | | | | - Alan Nichol
- BC Cancer Agency, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| |
Collapse
|
54
|
Leeman J, Birken SA, Powell BJ, Rohweder C, Shea CM. Beyond "implementation strategies": classifying the full range of strategies used in implementation science and practice. Implement Sci 2017; 12:125. [PMID: 29100551 PMCID: PMC5670723 DOI: 10.1186/s13012-017-0657-x] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/18/2017] [Indexed: 01/17/2023] Open
Abstract
Background Strategies are central to the National Institutes of Health’s definition of implementation research as “the study of strategies to integrate evidence-based interventions into specific settings.” Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term “implementation strategies.” We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues’ (2013) reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor) and the level and determinants that were targeted (i.e., the action targets). Main body We build on Wandersman and colleagues’ Interactive Systems Framework to distinguish strategies based on whether they are enacted by actors functioning as part of a Delivery, Support, or Synthesis and Translation System. We build on Damschroder and colleague’s Consolidated Framework for Implementation Research to distinguish the levels that strategies target (intervention, inner setting, outer setting, individual, and process). We then draw on numerous resources to identify determinants, which are conceptualized as modifiable factors that prevent or enable the adoption and implementation of evidence-based interventions. Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up. In our descriptions of each class, we identify the level of the Interactive System Framework at which the strategy is enacted (actors), level and determinants targeted (action targets), and outcomes used to assess strategy effectiveness. We illustrate how each class would apply to efforts to improve colorectal cancer screening rates in Federally Qualified Health Centers. Conclusions Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings. Organizing strategies into classes also will assist users in locating the strategies that best match their needs.
Collapse
Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, CB #7460, Chapel Hill, NC, 27599, USA.
| | - Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Christopher M Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| |
Collapse
|
55
|
Siembida EJ, Radhakrishnan A, Nowak SA, Parker AM, Pollack CE. Linking Reminders and Physician Breast Cancer Screening Recommendations: Results From a National Survey. JCO Clin Cancer Inform 2017; 1:1-10. [PMID: 30657396 DOI: 10.1200/cci.17.00090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Physician reminders have successfully increased rates of mammography. However, considering recent changes to breast cancer screening guidelines that disagree on the optimal age to start and stop mammography screening, we sought to examine the extent to which reminders have been deployed for breast cancer screening targeting younger and older patients. METHODS A mailed survey was sent to a national sample of 2,000 primary care physicians between May and September 2016. Physicians were asked whether they received reminders to screen women in various age groups (40 to 44, 45 to 49, and ≥ 75 years), the organizational screening guidelines they trusted most, and whether they recommended routine breast cancer screening to average-risk women in the different age groups. Using regression models, we assessed the association between reminders and physician screening recommendations, controlling for physician and practice characteristics, and evaluated whether the association varied by the guidelines they trusted. RESULTS A total of 871 physicians responded (adjusted response rate, 52.3%). Overall, 28.9% of physicians reported receiving reminders for patient ages 40 to 44 years, 32.5% for patient ages 45 to 49 years, and 16.5% for patient ages ≥ 75 years. Receiving reminders significantly increased the likelihood of physicians recommending mammography screening. In adjusted analyses, 84% (95% CI, 77% to 90%) of physicians who received reminders recommended screening for women ages ≥ 75 versus 65% (95% CI, 62% to 69%) of those who did not receive reminders. The associations between reminders and screening recommendations remained consistent regardless of which guidelines physicians reported trusting. CONCLUSION Reminders were significantly associated with increases in physician screening recommendations for mammography, underscoring the need for careful implementation in scenarios where guidelines are discordant.
Collapse
Affiliation(s)
- Elizabeth J Siembida
- Elizabeth J. Siembida, National Cancer Institute, Rockville; Craig Evan Pollack, Johns Hopkins University, Baltimore, MD; Archana Radhakrishnan, University of Michigan, Ann Arbor, MI; Sarah A. Nowak, RAND Corporation, Santa Monica, CA; and Andrew M. Parker, RAND Corporation, Pittsburgh, PA
| | - Archana Radhakrishnan
- Elizabeth J. Siembida, National Cancer Institute, Rockville; Craig Evan Pollack, Johns Hopkins University, Baltimore, MD; Archana Radhakrishnan, University of Michigan, Ann Arbor, MI; Sarah A. Nowak, RAND Corporation, Santa Monica, CA; and Andrew M. Parker, RAND Corporation, Pittsburgh, PA
| | - Sarah A Nowak
- Elizabeth J. Siembida, National Cancer Institute, Rockville; Craig Evan Pollack, Johns Hopkins University, Baltimore, MD; Archana Radhakrishnan, University of Michigan, Ann Arbor, MI; Sarah A. Nowak, RAND Corporation, Santa Monica, CA; and Andrew M. Parker, RAND Corporation, Pittsburgh, PA
| | - Andrew M Parker
- Elizabeth J. Siembida, National Cancer Institute, Rockville; Craig Evan Pollack, Johns Hopkins University, Baltimore, MD; Archana Radhakrishnan, University of Michigan, Ann Arbor, MI; Sarah A. Nowak, RAND Corporation, Santa Monica, CA; and Andrew M. Parker, RAND Corporation, Pittsburgh, PA
| | - Craig Evan Pollack
- Elizabeth J. Siembida, National Cancer Institute, Rockville; Craig Evan Pollack, Johns Hopkins University, Baltimore, MD; Archana Radhakrishnan, University of Michigan, Ann Arbor, MI; Sarah A. Nowak, RAND Corporation, Santa Monica, CA; and Andrew M. Parker, RAND Corporation, Pittsburgh, PA
| |
Collapse
|
56
|
Bowen ME, Bhat D, Fish J, Moran B, Howell-Stampley T, Kirk L, Persell SD, Halm EA. Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions. Am J Med Qual 2017; 33:237-245. [PMID: 29034685 DOI: 10.1177/1062860617732830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < .05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2% to 10%) and patient/medical exceptions (<3%). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73% vs 82%); breast (69% vs 75%), colorectal (58% vs 70%), and cervical cancer (53% vs 62%); and osteoporosis (72% vs 75%) screening ( P < .05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.
Collapse
Affiliation(s)
- Michael E Bowen
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| | - Deepa Bhat
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| | - Jason Fish
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| | - Brett Moran
- 1 University of Texas Southwestern Medical Center, Dallas, TX.,2 Parkland Health and Hospital System, Dallas, TX
| | | | - Lynne Kirk
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ethan A Halm
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
57
|
Winters S, Martin C, Murphy D, Shokar NK. Breast Cancer Epidemiology, Prevention, and Screening. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 151:1-32. [PMID: 29096890 DOI: 10.1016/bs.pmbts.2017.07.002] [Citation(s) in RCA: 285] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Globally, breast cancer is both the most commonly occurring cancer and the commonest cause of cancer death among women. Available data suggest that incidence and mortality in high-resource countries has been declining whereas incidence and mortality in low-resource countries has been increasing. This pattern is likely to be due to changing risk factor profiles and differences in access to breast cancer early detection and treatment. Risk factors for breast cancer include increasing age, race, menarche history, breast characteristics, reproductive patterns, hormone use, alcohol use, tobacco use, diet, physical activity, and body habitus. Mutations in the BRCA 1 and BRCA 2 tumor suppressor genes are significantly associated with the development of breast and ovarian cancer by the age of 70. Survival depends on both stage and molecular subtype. As there are few signs and symptoms early on, early detection is an important strategy to improve outcomes. Major professional organizations in the United States and elsewhere recommend screening with mammography with appropriate follow up for an abnormal screening test, although they differ somewhat by recommended ages and frequency of screening. Studies suggest a 15%-40% mortality reduction secondary to screening, however, there are also concerns about harms, such as overdiagnosis (5%-54%) and overtreatment leading to long term complications, and false negatives (6%-46%). Identification of women at risk for BRCA1 and BRCA 2 mutations is also recommended with referral for genetic testing. Preventive interventions, such as lifestyle, medical, and surgical options are available for women testing positive for BRCA mutations.
Collapse
Affiliation(s)
- Stella Winters
- Texas Tech University Health Sciences Center, El Paso, Paul L Foster School of Medicine, El Paso, TX, United States
| | - Charmaine Martin
- Texas Tech University Health Sciences Center, El Paso, Paul L Foster School of Medicine, El Paso, TX, United States
| | - Daniel Murphy
- Texas Tech University Health Sciences Center, El Paso, Paul L Foster School of Medicine, El Paso, TX, United States
| | - Navkiran K Shokar
- Texas Tech University Health Sciences Center, El Paso, Paul L Foster School of Medicine, El Paso, TX, United States.
| |
Collapse
|
58
|
Hadjipetrou A, Anyfantakis D, Galanakis CG, Kastanakis M, Kastanakis S. Colorectal cancer, screening and primary care: A mini literature review. World J Gastroenterol 2017; 23:6049-6058. [PMID: 28970720 PMCID: PMC5597496 DOI: 10.3748/wjg.v23.i33.6049] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/19/2017] [Accepted: 08/01/2017] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is a common health problem, representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality, with annual deaths estimated at 700000. The western way of life, that is being rapidly adopted in many regions of the world, is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore, the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians (PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein, we review the main topics of CRC in the current literature, in order to better understand its pathogenesis, risk and protective factors, as well as screening techniques. Furthermore, we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.
Collapse
Affiliation(s)
- Athanasios Hadjipetrou
- Primary Health Care Centre of Kissamos, Chania, 73400 Crete, Greece
- First Department of Surgery, Saint George General Hospital of Chania, 73300 Crete, Greece
| | - Dimitrios Anyfantakis
- Primary Health Care Centre of Kissamos, Chania, 73400 Crete, Greece
- First Department of Surgery, Saint George General Hospital of Chania, 73300 Crete, Greece
| | | | - Miltiades Kastanakis
- First Department of Surgery, Saint George General Hospital of Chania, 73300 Crete, Greece
| | - Serafim Kastanakis
- Department of Internal Medicine, Saint George General Hospital of Chania, 73300 Crete, Greece
| |
Collapse
|
59
|
Musa J, Achenbach CJ, O’Dwyer LC, Evans CT, McHugh M, Hou L, Simon MA, Murphy RL, Jordan N. Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis. PLoS One 2017; 12:e0183924. [PMID: 28873092 PMCID: PMC5584806 DOI: 10.1371/journal.pone.0183924] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Although cervical cancer is largely preventable through screening, detection and treatment of precancerous abnormalities, it remains one of the top causes of cancer-related morbidity and mortality globally. Objectives The objective of this systematic review is to understand the evidence of the effect of cervical cancer education compared to control conditions on cervical cancer screening rates in eligible women population at risk of cervical cancer. We also sought to understand the effect of provider recommendations for screening to eligible women on cervical cancer screening (CCS) rates compared to control conditions in eligible women population at risk of cervical cancer. Methods We used the PICO (Problem or Population, Interventions, Comparison and Outcome) framework as described in the Cochrane Collaboration Handbook to develop our search strategy. The details of our search strategy has been described in our systematic review protocol published in the International Prospective Register of systematic reviews (PROSPERO). The protocol registration number is CRD42016045605 available at: http://www.crd.york.ac.uk/prospero/display_record.asp?src=trip&ID=CRD42016045605. The search string was used in Pubmed, Embase, Cochrane Systematic Reviews and Cochrane CENTRAL register of controlled trials to retrieve study reports that were screened for inclusion in this review. Our data synthesis and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). We did a qualitative synthesis of evidence and, where appropriate, individual study effects were pooled in meta-analyses using RevMan 5.3 Review Manager. The Higgins I2 was used to assess for heterogeneity in studies pooled together for overall summary effects. We did assessment of risk of bias of individual studies included and assessed risk of publication bias across studies pooled together in meta-analysis by Funnel plot. Results Out of 3072 study reports screened, 28 articles were found to be eligible for inclusion in qualitative synthesis (5 of which were included in meta-analysis of educational interventions and 8 combined in meta-analysis of HPV self-sampling interventions), while 45 were excluded for various reasons. The use of theory-based educational interventions significantly increased CCS rates by more than double (OR, 2.46, 95% CI: 1.88, 3.21). Additionally, offering women the option of self-sampling for Human Papillomavirus (HPV) testing increased CCS rates by nearly 2-fold (OR = 1.71, 95% CI: 1.32, 2.22). We also found that invitation letters alone (or with a follow up phone contact), making an appointment, and sending reminders to patients who are due or overdue for screening had a significant effect on improving participation and CCS rates in populations at risk. Conclusion Our findings supports the implementation of theory-based cervical cancer educational interventions to increase women’s participation in cervical cancer screening programs, particularly when targeting communities with low literacy levels. Additionally, cervical cancer screening programs should consider the option of offering women the opportunity for self-sample collection particularly when such women have not responded to previous screening invitation or reminder letters for Pap smear collection as a method of screening.
Collapse
Affiliation(s)
- Jonah Musa
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
- * E-mail: , ,
| | - Chad J. Achenbach
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Linda C. O’Dwyer
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Charlesnika T. Evans
- Department of Preventive Medicine, Center for Health Care Studies, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, United States of America
| | - Megan McHugh
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Lifang Hou
- Division of Cancer Epidemiology, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Robert L. Murphy
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Neil Jordan
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Department of Preventive Medicine, Center for Health Care Studies, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Psychiatry & Behavioral Science, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| |
Collapse
|
60
|
Arditi C, Rège‐Walther M, Durieux P, Burnand B. Computer-generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2017; 7:CD001175. [PMID: 28681432 PMCID: PMC6483307 DOI: 10.1002/14651858.cd001175.pub4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting them to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. This is an update of a previously published review. OBJECTIVES To evaluate the effects of reminders automatically generated through a computerized system (computer-generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition). SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers up to 21 September 2016 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We included individual- or cluster-randomized and non-randomized trials that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals, alone (single-component intervention) or in addition to one or more co-interventions (multi-component intervention), compared with usual care or the co-intervention(s) without the reminder component. DATA COLLECTION AND ANALYSIS Review authors working in pairs independently screened studies for eligibility and abstracted data. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median improvement and interquartile range (IQR) across included studies using the primary outcome or median outcome as representative outcome. We assessed the certainty of the evidence according to the GRADE approach. MAIN RESULTS We identified 35 studies (30 randomized trials and five non-randomized trials) and analyzed 34 studies (40 comparisons). Twenty-nine studies took place in the USA and six studies took place in Canada, France, Israel, and Kenya. All studies except two took place in outpatient care. Reminders were aimed at enhancing compliance with preventive guidelines (e.g. cancer screening tests, vaccination) in half the studies and at enhancing compliance with disease management guidelines for acute or chronic conditions (e.g. annual follow-ups, laboratory tests, medication adjustment, counseling) in the other half.Computer-generated reminders delivered on paper to healthcare professionals, alone or in addition to co-intervention(s), probably improves quality of care slightly compared with usual care or the co-intervention(s) without the reminder component (median improvement 6.8% (IQR: 3.8% to 17.5%); 34 studies (40 comparisons); moderate-certainty evidence).Computer-generated reminders delivered on paper to healthcare professionals alone (single-component intervention) probably improves quality of care compared with usual care (median improvement 11.0% (IQR 5.4% to 20.0%); 27 studies (27 comparisons); moderate-certainty evidence). Adding computer-generated reminders delivered on paper to healthcare professionals to one or more co-interventions (multi-component intervention) probably improves quality of care slightly compared with the co-intervention(s) without the reminder component (median improvement 4.0% (IQR 3.0% to 6.0%); 11 studies (13 comparisons); moderate-certainty evidence).We are uncertain whether reminders, alone or in addition to co-intervention(s), improve patient outcomes as the certainty of the evidence is very low (n = 6 studies (seven comparisons)). None of the included studies reported outcomes related to harms or adverse effects of the intervention. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that computer-generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions.
Collapse
Affiliation(s)
- Chantal Arditi
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineLausanneSwitzerlandCH‐1005
| | - Myriam Rège‐Walther
- Lausanne University HospitalInstitute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneSwitzerland1010
| | - Pierre Durieux
- Georges Pompidou European HospitalDepartment of Public Health and Medical Informatics20 rue LeblancParisFrance75015
| | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineLausanneSwitzerlandCH‐1005
| | | |
Collapse
|
61
|
Tangka FKL, Subramanian S. Importance of implementation economics for program planning-evaluation of CDC's colorectal cancer control program. EVALUATION AND PROGRAM PLANNING 2017; 62:64-66. [PMID: 28034480 PMCID: PMC5847314 DOI: 10.1016/j.evalprogplan.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA.
| | - Sujha Subramanian
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452 USA.
| |
Collapse
|
62
|
Rice K, Gressard L, DeGroff A, Gersten J, Robie J, Leadbetter S, Glover-Kudon R, Butterly L. Increasing colonoscopy screening in disparate populations: Results from an evaluation of patient navigation in the New Hampshire Colorectal Cancer Screening Program. Cancer 2017; 123:3356-3366. [PMID: 28464213 DOI: 10.1002/cncr.30761] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND To investigate uniformly successful results from a statewide program of patient navigation (PN) for colonoscopy, this comparison study evaluated the effectiveness of the PN intervention by comparing outcomes for navigated versus non-navigated patients in one of the community health clinics included in the statewide program. Outcomes measured included screening completion, adequacy of bowel preparation, missed appointments and cancellations, communication of test results, and consistency of follow-up recommendations with clinical guidelines. METHODS The authors compared a subset of 131 patients who were navigated to a screening or surveillance colonoscopy with a similar subset of 75 non-navigated patients at one endoscopy clinic. The prevalence and prevalence odds ratios were computed to measure the association between PN and each study outcome measure. RESULTS Patients in the PN intervention group were 11.2 times more likely to complete colonoscopy than control patients (96.2% vs 69.3%; P<.001), and were 5.9 times more likely to have adequate bowel preparation (P =.010). In addition, intervention patients had no missed appointments compared with 15.6% of control patients, and were 24.8 times more likely to not have a cancellation <24 hours before their appointment (P<.001). All navigated patients and their primary care providers received test results, and all follow-up recommendations were consistent with clinical guidelines compared with 82.4% of patients in the control group (P<.001). CONCLUSIONS PN appears to be effective for improving colonoscopy screening completion and quality in the disparate populations most in need of intervention. To the best of our knowledge, the results of the current study demonstrate some of the strongest evidence for the effectiveness of PN to date, and highlight its value for public health. Cancer 2017;123:3356-66. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Ketra Rice
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindsay Gressard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joanne Gersten
- New Hampshire Colorectal Cancer Screening Program, Mary Hitchcock Memorial Hospital, Lebanon, New Hampshire
| | - Janene Robie
- New Hampshire Colorectal Cancer Screening Program, Mary Hitchcock Memorial Hospital, Lebanon, New Hampshire
| | - Steven Leadbetter
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca Glover-Kudon
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lynn Butterly
- New Hampshire Colorectal Cancer Screening Program, Mary Hitchcock Memorial Hospital, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| |
Collapse
|
63
|
Lofters AK, Vahabi M, Prakash V, Banerjee L, Bansal P, Goel S, Dunn S. Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement. Patient Prefer Adherence 2017; 11:495-503. [PMID: 28331296 PMCID: PMC5352230 DOI: 10.2147/ppa.s127147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach. MATERIALS AND METHODS Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months. RESULTS Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer) to 44.6% (breast cancer) of patients came in for screening within six months of the first phone calls. Although physicians viewed the health ambassadors positively, they found the study to be time intensive and resource intensive, especially as this work was additional to usual clinical duties. DISCUSSION Using South Asian lay health educators embedded within primary care practices to telephone patients in their own languages showed promise in this study to increase awareness about willingness to screen and cancer screening uptake, but it was also time intensive and resource intensive with numerous challenges. Future quality improvement efforts should further develop the phone call invitation process, as well as explore how to provide infrastructure for lay health educator training and time.
Collapse
Affiliation(s)
- AK Lofters
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Department of Family and Community Medicine
- Centre for Urban Health Solutions, St Michael’s Hospital
| | - M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto
| | - V Prakash
- Screening Saves Lives Program, Canadian Cancer Society, Mississauga
| | - L Banerjee
- Wise Elephant Family Health Team, Brampton
| | - P Bansal
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Goel
- Wise Elephant Family Health Team, Brampton
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Dunn
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| |
Collapse
|
64
|
Ambrose P, Zepf R, Parrott AH, Dawson-Rose C. Prevalence of Hepatitis C Screening in an HIV Primary Care Clinic. J Assoc Nurses AIDS Care 2016; 28:422-427. [PMID: 27939429 DOI: 10.1016/j.jana.2016.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/31/2016] [Indexed: 12/22/2022]
|
65
|
Lee SJC, Clark MA, Cox JV, Needles BM, Seigel C, Balasubramanian BA. Achieving Coordinated Care for Patients With Complex Cases of Cancer: A Multiteam System Approach. J Oncol Pract 2016; 12:1029-1038. [PMID: 27577621 PMCID: PMC5356468 DOI: 10.1200/jop.2016.013664] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patients with cancer with multiple chronic conditions pose a unique challenge to how primary care and specialty care teams provide well-coordinated, patient-centered care. Effectiveness of these care teams in providing optimal health care depends on the extent to which they coordinate their goals and knowledge as components of a multiteam system (MTS). This article outlines challenges of care coordination in the context of an MTS, illustrated through the care experience of "Mr Fuentes," a patient in the Dallas County integrated safety-net system, Parkland. As a continuing patient with chronic illnesses, the patient being discussed is managed through one of the Parkland community-oriented primary care clinics. However, a cancer diagnosis triggered an additional need for augmented coordination between his different provider teams. Further research and practice should investigate the relationships of MTS coordination for shared care management, transfer to and from specialty care, treatment compliance, barriers to care, and health outcomes of chronic comorbid conditions, as well as cancer control and surveillance.
Collapse
Affiliation(s)
- Simon J. Craddock Lee
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Mark A. Clark
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - John V. Cox
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Burton M. Needles
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Carole Seigel
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Bijal A. Balasubramanian
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| |
Collapse
|
66
|
Richman IB. Capsule Commentary on Schapira et al., Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice. J Gen Intern Med 2016; 31:1215. [PMID: 27216481 PMCID: PMC5023606 DOI: 10.1007/s11606-016-3748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ilana Beth Richman
- Palo Alto VA Health Care System/Stanford University School of Medicine, Palo Alto, CA, USA.
| |
Collapse
|
67
|
Ma H, Dai H, Duan X, Tang Z, Liu R, Sun K, Zhou K, Chen H, Xiang H, Wang J, Gao Q, Zou Y, Wan H, Teh MT. Independent evaluation of a FOXM1-based quantitative malignancy diagnostic system (qMIDS) on head and neck squamous cell carcinomas. Oncotarget 2016; 7:54555-54563. [PMID: 27409343 PMCID: PMC5342363 DOI: 10.18632/oncotarget.10512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/23/2016] [Indexed: 01/29/2023] Open
Abstract
The forkhead box M1 (FOXM1) transcription factor gene has been implicated in almost all human cancer types. It would be an ideal biomarker for cancer detection but, to date, its translation into a cancer diagnostic tool is yet to materialise. The quantitative Malignancy Index Diagnostic System (qMIDS) was the first FOXM1 oncogene-based diagnostic test developed for quantifying squamous cell carcinoma aggressiveness. The test was originally validated using head and neck squamous cell carcinomas (HNSCC) from European patients. The HNSCC gene expression signature across geographical and ethnic differences is unknown. This is the first study evaluated the FOXM1-based qMIDS test using HNSCC specimens donated by ethnic Chinese patients. We tested 50 Chinese HNSCC patients and 18 healthy subjects donated 68 tissues in total. qMIDS scores from the Chinese cohort were compared with the European datasets (n = 228). The median ± SD scores for the Chinese cohort were 1.13 ± 0.66, 4.02 ± 1.66 and 5.83 ± 3.13 in healthy oral tissues, adjacent tumour margin and HNSCC core tissue, respectively. Diagnostic test efficiency between the Chinese and European datasets was almost identical. Consistent with previous European data, qMIDS scores for HNSCC samples were not influenced by gender or age. The degree of HNSCC differentiation, clinical stage and lymphatic metastasis status were found to be correlated with qMIDS scores. This study provided the first evidence that the pathophysiology of HNSCC was molecularly indistinguishable between the Chinese and European specimens. The qMIDS test robustly quantifies a universal FOXM1-driven oncogenic program, at least in HNSCC, which transcends ethnicity, age, gender and geographic origins.
Collapse
Affiliation(s)
- Hong Ma
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Haiyan Dai
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Xiaofeng Duan
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Zhenglong Tang
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Rui Liu
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Kunjun Sun
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Ke Zhou
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Hao Chen
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Hang Xiang
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Jinsheng Wang
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Qiong Gao
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Yuan Zou
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
| | - Hong Wan
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, England, United Kingdom
| | - Muy-Teck Teh
- China-British Joint Molecular Head and Neck Cancer Research Laboratory, Department of Oral and Maxillofacial Surgery, Hospital and School of Stomatology, Guizhou Medical University, Guizhou, China
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, England, United Kingdom
| |
Collapse
|
68
|
Abstract
BACKGROUND We examined mammography use before and after Medicare eliminated cost sharing for screening mammography in January 2011. METHODS Using National Health Interview Survey data, we examined changes in mammography use between 2010 and 2013 among Medicare beneficiaries aged 65-74 years. Logistic regression and predictive margins were used to examine changes in use after adjusting for covariates. RESULTS In 2013, 74.7% of women reported a mammogram within 2 years, a 3.5 percentage point increase (95% confidence interval, -0.3, 7.2) compared with 2010. Increases occurred among women aged 65-69 years, unmarried women, and women with usual sources of care and 2-5 physician visits in the prior year. After adjustment, mammography use increased in 2013 versus 2010 (74.8% vs. 71.3%, P=0.039). Interactions between year and income, insurance, race, or ethnicity were not significant. CONCLUSIONS There was a modest increase in mammography use from 2010 to 2013 among Medicare beneficiaries aged 65-74 years, possibly consistent with an effect of eliminating Medicare cost sharing during this time. Findings suggest that eliminating cost sharing might increase use of recommended screening services.
Collapse
|
69
|
Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care. Br J Gen Pract 2016; 66:e483-90. [PMID: 27266861 DOI: 10.3399/bjgp16x685657] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/25/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Participation rates in colorectal cancer screening are below recommended European targets. AIM To evaluate the effectiveness of an alert in primary care electronic medical records (EMRs) to increase individuals' participation in an organised, population-based colorectal cancer screening programme when compared with usual care. DESIGN AND SETTING Cluster randomised controlled trial in primary care centres of Barcelona, Spain. METHOD Participants were males and females aged 50-69 years, who were invited to the first round of a screening programme based on the faecal immunochemical test (FIT) (n = 41 042), and their primary care professional. The randomisation unit was the physician cluster (n = 130) and patients were blinded to the study group. The control group followed usual care as per the colorectal cancer screening programme. In the intervention group, as well as usual care, an alert to health professionals (cluster level) to promote screening was introduced in the individual's primary care EMR for 1 year. The main outcome was colorectal cancer screening participation at individual participant level. RESULTS In total, 67 physicians and 21 619 patients (intervention group) and 63 physicians and 19 423 patients (control group) were randomised. In the intention-to-treat analysis screening participation was 44.1% and 42.2% respectively (odds ratio 1.08, 95% confidence interval [CI] = 0.97 to 1.20, P = 0.146). However, in the per-protocol analysis screening uptake in the intervention group showed a statistically significant increase, after adjusting for potential confounders (OR, 1.11; 95% CI = 1.02 to 1.22; P = 0.018). CONCLUSION The use of an alert in an individual's primary care EMR is associated with a statistically significant increased uptake of an organised, FIT-based colorectal cancer screening programme in patients attending primary care centres.
Collapse
|
70
|
Fedewa SA, de Moor JS, Ward EM, DeSantis CE, Goding Sauer A, Smith RA, Jemal A. Mammography Use and Physician Recommendation After the 2009 U.S. Preventive Services Task Force Breast Cancer Screening Recommendations. Am J Prev Med 2016; 50:e123-e131. [PMID: 26699245 DOI: 10.1016/j.amepre.2015.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In 2009, the U.S. Preventive Services Task Force (USPSTF) no longer recommended routine mammography for women aged 40-49 and ≥75 years (younger and older women, respectively). Whether mammography usage and physician recommendation among younger and older women changed in response to these recommendations is unclear. METHODS Cross-sectional data from women aged ≥40 years in the 2008 and 2013 National Health Interview Surveys were used (n=4,942 younger and 3,047 older women) and were analyzed in 2015. Changes between 2008 and 2013 in self-reports about having undergone mammography in the past 2 years and physician recommendation for mammography were expressed as adjusted prevalence difference (PD) and 95% CI. RESULTS Overall, adjusted prevalence of mammography among younger women was similar in 2008 (62.2%) and 2013 (58.5%) (p=0.05), but significantly declined in high-income (PD=-6.1%, 95% CI=-11.2, -1.0); non-Hispanic white (PD=-5.5%, 95% CI=-10.2, -0.8); and privately insured (PD=-5.7%, 95% CI=-9.8, -1.6) younger women. For older women, there was no change in adjusted mammography prevalence overall (2008, 56.2%; 2013, 54.2%; p=0.473) or by SES. Physician mammography recommendation declined in younger (PD=-5.0%, 95% CI=-8.7, -1.3) and older (PD=-5.8%, 95% CI=-10.5, -1.1) women. CONCLUSIONS Four years after publication of USPSTF mammography recommendations, mammography prevalence for younger and older women did not significantly decrease except for higher-SES younger women. The significant decrease in physician recommendation of mammography in younger and older women may reflect a change in practice patterns by some physicians in response to USPSTF recommendations.
Collapse
Affiliation(s)
- Stacey A Fedewa
- Intramural Research Department, American Cancer Society, Atlanta, Georgia; Department of Epidemiology, Emory University, Atlanta, Georgia.
| | - Janet S de Moor
- Healthcare Assessment Research Branch, National Cancer Institute, Bethesda, Maryland
| | - Elizabeth M Ward
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Carol E DeSantis
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Cancer Control Sciences, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
71
|
Goel MS, O'Conor R. Increasing screening mammography among predominantly Spanish speakers at a federally qualified health center using a brief previsit video. PATIENT EDUCATION AND COUNSELING 2016; 99:408-413. [PMID: 26456634 DOI: 10.1016/j.pec.2015.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/03/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Assess the impact of a 5min video on screening mammogram referrals and completion. METHODS We recruited women ages 40 years or older without a current mammogram at a federally qualified community health center (FQHC). Women were assigned to the intervention or usual care. Immediately prior to their appointments, women in the intervention group viewed a brief video that included a demonstration of how patients may request a mammogram referral. All women completed a pre- and post-visit telephone survey about knowledge of breast cancer screening and patient activation. RESULTS Mean age was 52 years, 50% had less than a high school education and 75% preferred Spanish. The proportion of mammogram referrals in the intervention group was significantly higher than the control group, 37% vs. 15%, respectively (p<0.01). Similarly, the intervention group had a higher proportion of completed mammograms, 33% vs. 13% (p<0.02). There were no differences in breast cancer knowledge or patient activation between the intervention and control groups. CONCLUSIONS A brief, pre-visit video significantly increased screening mammography referrals and completion in this mostly Spanish-speaking FQHC population. PRACTICE IMPLICATIONS Our intervention demonstrates the effectiveness of a brief-video intervention in a population with low education and low English language proficiency.
Collapse
Affiliation(s)
- Mita Sanghavi Goel
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, United States.
| | - Rachel O'Conor
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, United States
| |
Collapse
|
72
|
Muliira JK, D'Souza MS, Ahmed SM. Contrasts in Practices and Perceived Barriers to Colorectal Cancer Screening by Nurses and Physicians Working in Primary Care Settings in Oman. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:15-25. [PMID: 25739678 DOI: 10.1007/s13187-015-0806-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Colorectal cancer (CRC) is the fourth most common type of cancer worldwide and it is responsible for 610,000 deaths annually, despite availability of screening tests that ensure early detection. Predictions specific to the Middle East show that this region will experience a significant increase in cancer mortality over the next 15 years. This study explored the practices and perceived barriers to CRC screening from the perspective of health care providers (HCPs) working in primary care settings in Muscat, Oman. A cross-sectional design and self-administered questionnaires were used to collect data from 142 HCPs. The HCPs were nurses (57.7 %) and physicians (42.3 %) with average age and clinical experience of 32.5 and 9.5 years, respectively. The majority of the HCPs (64.8 %) rarely ordered, referred, health educated, or recommended CRC screening to eligible patients. The only major patient-related barrier to CRC screening reported by HCPs was lack of awareness about CRC tests (63.7 %). There were significant differences between nurses' and physicians' rating of patient-related barriers such as fear of cancer diagnosis (p = 0.037), belief that screening is not effective (p = 0.036), embarrassment or anxiety about screening tests (p = 0.022), and culture (p = 0.001). The major system barriers to CRC screening were lack of hospital policy or protocols, lack of trained HCPs, lack of CRC screening services, and timely appointments to get CRC screening. The findings indicate a need for interventions to enhance patient awareness, HCPs CRC screening practices, and strategies to ameliorate patient and system barriers to CRC screening.
Collapse
Affiliation(s)
- Joshua Kanaabi Muliira
- College of Nursing, Department of Adult Health and Critical Care, Sultan Qaboos University, P. O. Box 66, 123, Al Khod, Muscat, Oman.
| | - Melba Sheila D'Souza
- College of Nursing, Department of Adult Health and Critical Care, Sultan Qaboos University, P. O. Box 66, 123, Al Khod, Muscat, Oman
| | - Samira Maroof Ahmed
- College of Nursing, Department of Community Health and Psychiatric Mental Health, Sultan Qaboos University, P. O. Box 66, 123, Al Khod, Muscat, Oman
| |
Collapse
|
73
|
Worksite Cancer Prevention Activities in the National Comprehensive Cancer Control Program. J Community Health 2016; 41:838-44. [PMID: 26874944 DOI: 10.1007/s10900-016-0161-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Workplaces are one setting for cancer control planners to reach adults at risk for cancer and other chronic diseases. However, the extent to which Centers for Disease Control and Prevention-funded National Comprehensive Cancer Control Programs (NCCCP) implement interventions in the workplace setting is not well characterized. We conducted a qualitative content analysis of program action plans submitted by NCCCP grantees from 2013 to 2015 to identify and describe cancer prevention objectives and interventions in the workplace setting. Nearly half of NCCCP action reports contained at least one cancer prevention objective or intervention in the workplace setting. Common interventions included education about secondhand smoke exposure in the workplace, and the importance of obtaining colorectal cancer screening. Workplace interventions were relatively common among NCCCP action plans, and serve as one way to address low percentages of CRC screening, and reduce risk for obesity- and tobacco-related cancers.
Collapse
|
74
|
Plourde N, Brown HK, Vigod S, Cobigo V. Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature. Women Health 2016; 56:906-25. [PMID: 26812962 DOI: 10.1080/03630242.2016.1145169] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However, contextual factors, such as service organization, as well as healthcare providers' training and practices, are more feasibly altered to increase health service use. The objective of the authors in this study was to perform a critical systematic review of the literature to identify contextual factors at the provider- and system-level that were associated with breast and cervical cancer screening uptake. Studies published from 2000 to 2013 were identified through PubMed and PsycInfo. Methodologic quality was assessed, and studies were examined for themes related to provider- and system-level factors associated with screening uptake. Thirteen studies met the inclusion criteria. Findings revealed a positive association between patients' receipt of provider recommendation and uptake of breast and cervical cancer screening. Uptake was also higher among patients of female providers. Facilities with flexible appointment times and reminders had higher mammography and Pap test uptake. Similarly, greater organizational commitment to quality and performance had higher breast and cervical cancer screening rates. Knowledge provided in this review could be used in future research to inform the development of public health policy and clinical programs to improve screening uptake.
Collapse
Affiliation(s)
- Natasha Plourde
- c School of Psychology , University of Ottawa , Ottawa , Ontario , Canada
| | - Hilary K Brown
- a Women's College Research Institute , Toronto , Ontario , Canada
| | - Simone Vigod
- b Women's Mental Health Program , Women's College Hospital , Toronto , Ontario , Canada
| | - Virginie Cobigo
- c School of Psychology , University of Ottawa , Ottawa , Ontario , Canada
| |
Collapse
|
75
|
Denson V, Keele R. Cervical Cancer Screening Practices of Volunteer Providers in Faith-based Clinics. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2015.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
76
|
¿Debemos redefinir la población diana en el cribado de cáncer cervical con la técnica de Papanicolaou? CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2015. [DOI: 10.1016/j.gine.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
77
|
Shultz CG, Malouin JM, Green LA, Plegue M, Greenberg GM. A Systems Approach to Improving Tdap Immunization Within 5 Community-Based Family Practice Settings: Working Differently (and Better) by Transforming the Structure and Process of Care. Am J Public Health 2015; 105:1990-7. [PMID: 26270283 PMCID: PMC4566568 DOI: 10.2105/ajph.2015.302739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined how family medicine clinic physicians and staff worked in collaborative teams to implement an automated clinical reminder to improve tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine administration and documentation. METHODS A clinical reminder was developed at 5 University of Michigan family medicine clinics to identify patients 11 to 64 years old who were in need of the Tdap booster vaccine. Quality improvement cycles were used to improve clinic care processes. Immunization rates from 2008 to 2011 were compared with rates at 4 primary care control clinics. RESULTS Vaccination rates among eligible patients increased from 15.5% to 47.3% within the family medicine clinics and from 14.1% to 30.2% within the control clinics. After adjustment for covariates, family medicine patients had a higher probability of vaccination than control patients during each measurement period (0.17 vs 0.15 at baseline, 0.53 vs 0.22 during year 1, and 0.50 vs 0.30 during year 2). CONCLUSIONS Automated clinical reminders, when designed and implemented via a consensus-based framework that addresses the process of care, can dramatically improve provision of preventive health care.
Collapse
Affiliation(s)
- Cameron G Shultz
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
| | - Jean M Malouin
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
| | - Lee A Green
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
| | - Melissa Plegue
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
| | - Grant M Greenberg
- Cameron G. Shultz, Jean M. Malouin, Melissa Plegue, and Grant M. Greenberg are with the Department of Family Medicine, University of Michigan, Ann Arbor. Lee A. Green is with the Department of Family Medicine, University of Alberta, Edmonton
| |
Collapse
|
78
|
Angier H, Marino M, Sumic A, O'Malley J, Likumahuwa-Ackman S, Hoopes M, Nelson C, Gold R, Cohen D, Dickerson K, DeVoe JE. Innovative methods for parents and clinics to create tools for kids' care (IMPACCT Kids' Care) study protocol. Contemp Clin Trials 2015; 44:159-163. [PMID: 26291916 DOI: 10.1016/j.cct.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite expansions in public health insurance, many children remain uninsured or experience gaps in coverage. Community health centers (CHCs) provide primary care to many children at risk for uninsurance and are well-positioned to help families obtain and retain children's coverage. Recent advances in health information technology (HIT) capabilities provide the means to create tools that could enhance CHCs' insurance outreach efforts. OBJECTIVE To present the study design, baseline patient characteristics, variables, and statistical methods for the Innovative Methods for Parents And Clinics to Create Tools for Kids' Care (IMPACCT Kids' Care) study. METHODS/DESIGN In this mixed methods study, we will design, test and refine health insurance outreach HIT tools through a user-centered process. We will then implement the tools in four CHCs and evaluate their effectiveness and barriers and facilitators to their implementation. To measure effectiveness, we will quantitatively assess health insurance coverage continuity and utilization of healthcare services for pediatric patients in intervention CHCs compared to matched control sites using electronic health record (EHR) and Oregon Medicaid administrative data over 18months pre- and 18months post-implementation (n=34,867 children). We will also qualitatively assess the implementation process to understand how the tools fit into the clinics' workflows and the CHC staff experiences with the tools. CONCLUSIONS This study creates, implements, and evaluates health insurance outreach HIT tools. The use of such tools will likely improve care delivery and health outcomes, reduce healthcare disparities for vulnerable populations, and enhance overall healthcare system performance. ClinicalTrials.gov Identifier: NCT02298361.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Rachel Gold
- OCHIN, Inc., USA; Kaiser Permanente Center for Health Research, USA
| | | | | | | |
Collapse
|
79
|
Knight JR, Kanotra S, Siameh S, Jones J, Thompson B, Thomas-Cox S. Understanding Barriers to Colorectal Cancer Screening in Kentucky. Prev Chronic Dis 2015; 12:E95. [PMID: 26086608 PMCID: PMC4473604 DOI: 10.5888/pcd12.140586] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Colorectal cancer screening rates have increased significantly in Kentucky, from 35% in 1999 to 66% in 2012. A continued improvement in screening requires identification of existing barriers and implementation of interventions to address barriers. Methods The state of Kentucky added a question to the 2012 Kentucky Behavioral Risk Factor Surveillance System survey for respondents aged 50 years or older who answered no to ever having been screened for colorectal cancer by colonoscopy or sigmoidoscopy to assess the reasons why respondents had not been screened. Combined responses constituted 4 categories: attitudes and beliefs, health care provider and health care systems barriers, cost, and other. Prevalence estimates for barriers were calculated by using raking weights and were stratified by race/ethnicity, sex, education, income, and health insurance coverage. Logistic regression estimated odds ratios for barriers to screening. Results The most common barriers in all areas were related to attitudes and beliefs, followed by health care provider and systems, and cost. Non-Hispanic whites and respondents with more than a high school education were more likely to choose attitudes and beliefs as a barrier than were non-Hispanic blacks and those with less than a high school education. Respondents with low incomes and with no insurance were significantly more likely to select cost as a barrier. No significant associations were observed between demographic variables and the selection of a health care provider and a health care system. Conclusion Barriers related to education, race/ethnicity, income, and insurance coverage should be considered when designing interventions. Expansion of Medicaid and implementation of the Affordable Care Act in Kentucky could have an impact on reducing these barriers.
Collapse
Affiliation(s)
| | | | - Seth Siameh
- Kentucky Department for Public Health, Frankfort, Kentucky
| | | | - Becki Thompson
- Kentucky Department for Public Health, Frankfort, Kentucky
| | - Sue Thomas-Cox
- Kentucky Department for Public Health, Frankfort, Kentucky
| |
Collapse
|
80
|
Qureshi AI, Malik AA, Saeed O, Adil MM, Rodriguez GJ, Suri MFK. Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients. Cerebrovasc Dis 2015; 39:262-8. [DOI: 10.1159/000375154] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/12/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Subclinical cancer can manifest as a thromboembolic event and may be detected at a later interval in ischemic stroke survivors. We determined the rate of incident cancer and effect on cardiovascular endpoints in a large cohort of ischemic stroke survivors. Methods: An analysis of 3,680 adults with nondisabling cerebral infarction who were followed for two years within the randomized, double-blinded VISP trial was performed. The primary intervention was best medical/surgical management plus a daily supplementation of vitamin B6, vitamin B12, and folic acid. We calculated age-adjusted rates of incidence of cancer among ischemic stroke survivors and standardized incidence ratios (SIR) with 95% confidence intervals (CI) based on comparison with age-adjusted rates in the general population. The significant variables from univariate analysis were entered in a Cox Proportional Hazards analysis to identify the association between various baseline factors and incident cancer after adjusting age, gender, and race/ethnicity. A logistic regression analysis evaluated the association between incident cancer and various endpoints including stroke, coronary heart disease, myocardial infarction, and death after adjusting age, gender, and race/ethnicity. Results: A total of 3,247 patients (mean age ± SD of 66 ± 11; 2,013 were men) were cancer free at the time of enrollment. The incidence of new cancer was 0.15, 0.80, 1.2, and 2.0 per 100 patients at 1 month, 6 months, 1 year, and 2 years, respectively. The age-adjusted annual rate of cancer in patients with ischemic stroke was higher than in persons in the general population at 1 year (581.8/100,000 persons vs. 486.5/100,000 persons, SIR 1.2, 95% CI 1.16-1.24) and 2 years (1,301.7/100,000 vs. 911.5/100,000, SIR 1.4, 95% CI 1.2-1.6) after recruitment. There was a higher risk for death (odds ratio (OR) 3.1, 95% CI 1.8-5.4), and composite endpoint of stroke, coronary heart disease, and/or death (OR 1.4, 95% CI 1.0-2.2) among participants who developed incident cancer compared with those who were cancer free after adjusting for potential confounders. Conclusions: The annual rate of age-adjusted cancer incidence was higher among ischemic stroke patients compared with those in the general population. The odds of mortality were three folds higher among stroke survivors who developed incident cancer.
Collapse
|
81
|
Gagliardi AR, Abdallah F, Faulkner G, Ciliska D, Hicks A. Factors contributing to the effectiveness of physical activity counselling in primary care: a realist systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:412-419. [PMID: 25499578 DOI: 10.1016/j.pec.2014.11.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 11/17/2014] [Accepted: 11/23/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Physical activity (PA) counselling in primary care increases PA but is not consistently practiced. This study examined factors that optimise the delivery and impact of PA counselling. METHODS A realist systematic review based on the PRECEDE-PROCEED model and RAMESES principles was conducted to identify essential components of PA counselling. MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Physical Education Index were searched from 2000 to 2013 for studies that evaluated family practice PA counselling. RESULTS Of 1546 articles identified, 10 were eligible for review (3 systematic reviews, 5 randomised controlled trials, 2 observational studies). Counselling provided by clinicians or counsellors alone that explored motivation increased self-reported PA at least 12 months following intervention. Multiple sessions may sustain increased PA beyond 12 months. CONCLUSION Given the paucity of eligible studies and limited detail reported about interventions, further research is needed to establish the optimal design and delivery of PA counselling. Research and planning should consider predisposing, reinforcing and enabling design features identified in these studies. PRACTICE IMPLICATIONS Since research shows that PA counselling promotes PA but is not widely practiced, primary care providers will require training and tools to operationalize PA counselling.
Collapse
Affiliation(s)
- Anna R Gagliardi
- University Health Network, 200 Elizabeth Street, Toronto, Canada.
| | | | | | | | | |
Collapse
|
82
|
Bowen ME, Xuan L, Lingvay I, Halm EA. Random blood glucose: a robust risk factor for type 2 diabetes. J Clin Endocrinol Metab 2015; 100:1503-10. [PMID: 25650899 PMCID: PMC4399288 DOI: 10.1210/jc.2014-4116] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Although random blood glucose (RBG) values are common in clinical practice, the role of elevated RBG values as a risk factor for type 2 diabetes is not well described. OBJECTIVE This study aimed to examine nondiagnostic, RBG values as a risk factor for type 2 diabetes DESIGN This was a cross-sectional study of National Health and Nutrition Examination Surveys (NHANES) participants (2005-2010). PARTICIPANTS Nonfasting NHANES participants (n = 13 792) without diagnosed diabetes were included. PRIMARY OUTCOME The primary outcome was glycemic status (normal glycemia, undiagnosed prediabetes, or undiagnosed diabetes) using hemoglobin HbA1C as the criterion standard. ANALYSIS Multinomial logistic regression examined associations between diabetes risk factors and RBG values according to glycemic status. Associations between current U.S. screening strategies and a hypothetical RBG screening strategy with undiagnosed diabetes were examined. RESULTS In unadjusted analyses, a single RBG ≥ 100 mg/dL (5.6 mmol/L) was more strongly associated with undiagnosed diabetes than any single risk factor (odds ratio [OR], 31.2; 95% confidence interval [CI], 21.3-45.5) and remained strongly associated with undiagnosed diabetes (OR, 20.4; 95% CI, 14.0-29.6) after adjustment for traditional diabetes risk factors. Using RBG < 100 mg/dL as a reference, the adjusted odds of undiagnosed diabetes increased significantly as RBG increased. RBG 100-119 mg/dL (OR 7.1; 95% CI 4.4-11.4); RBG 120-139 mg/dL (OR 30.3; 95% CI 20.0-46.0); RBG ≥ 140 mg/dL (OR 256; 95% CI 150.0-436.9). As a hypothetical screening strategy, an elevated RBG was more strongly associated with undiagnosed diabetes than current United States Preventative Services Task Force guidelines (hypertension alone; P < .0001) and similar to American Diabetes Association guidelines (P = .12). CONCLUSIONS A single RBG ≥ 100 mg/dL is more strongly associated with undiagnosed diabetes than traditional risk factors. Abnormal RBG values are a risk factor for diabetes and should be considered in screening guidelines.
Collapse
Affiliation(s)
- Michael E Bowen
- Division of General Internal Medicine, Department of Medicine (M.E.B., E.A.H.), Division of Outcomes and Health Services Research, Department of Clinical Sciences (M.E.B., L.X., E.A.H.), Division of Endocrinology, Department of Medicine (I.L.), and Department of Clinical Sciences (I.L.), University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | | | | | | |
Collapse
|
83
|
Escoffery C, Hannon P, Maxwell AE, Vu T, Leeman J, Dwyer A, Mason C, Sowles S, Rice K, Gressard L. Assessment of training and technical assistance needs of Colorectal Cancer Control Program Grantees in the U.S. BMC Public Health 2015; 15:49. [PMID: 25636329 PMCID: PMC4318175 DOI: 10.1186/s12889-015-1386-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 01/09/2015] [Indexed: 12/03/2022] Open
Abstract
Background Practitioners often require training and technical assistance to build their capacity to select, adapt, and implement evidence-based interventions (EBIs). The CDC Colorectal Cancer Control Program (CRCCP) aims to promote CRC screening to increase population-level screening. This study identified the training and technical assistance (TA) needs and preferences for training related to the implementation of EBIs among CRCCP grantees. Methods Twenty-nine CRCCP grantees completed an online survey about their screening activities, training and technical assistance in 2012. They rated desire for training on various evidence-based strategies to increase cancer screening, evidence-based competencies, and program management topics. They also reported preferences for training formats and facilitators and barriers to trainings. Results Many CRCCP grantees expressed the need for training with regards to specific EBIs, especially system-level and provider-directed EBIs to promote CRC screening. Grantees rated these EBIs as more difficult to implement than client-oriented EBIs. Grantees also reported a moderate need for training regarding finding EBIs, assessing organizational capacity, implementing selected EBIs, and conducting process and outcome evaluations. Other desired training topics reported with higher frequency were partnership development and data collection/evaluation. Grantees preferred training formats that were interactive such as on-site trainings, webinars or expert consultants. Conclusions Public health organizations need greater supports for adopting evidence-based interventions, working with organizational-level change, partnership development and data management. Future capacity building efforts for the adoption of EBIs should focus on systems or provider level interventions and key processes for health promotion and should be delivered in a variety of ways to assist local organizations in cancer prevention and control. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1386-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Road, 5th Floor, Atlanta, GA, 30322, USA.
| | - Peggy Hannon
- University of Washington, Health Promotion Research Center, 1107 NE 45th Street, Ste. 200, Seattle, WA, 98105, USA.
| | - Annette E Maxwell
- University of California, 650 Charles Young Drive South (A2-125 CHS), Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Thuy Vu
- University of Washington, Health Promotion Research Center, 1107 NE 45th Street, Ste. 200, Seattle, WA, 98105, USA.
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, School of Nursing, Room 2006, Chapel Hill, NC, 27599, USA.
| | - Andrea Dwyer
- University of Colorado, 13001 East 17th Bldg 500, Office Number W6104-D, Aurora, CO, 80045, USA.
| | - Caitlin Mason
- University of Washington, Department of Health Services, Campus Mail Box 354804, 1107 NE 45th Street, Suite 200, Seattle, WA, 98105, USA.
| | - Shaina Sowles
- Washington University, Campus Box 1009, North Campus, Room 1549, 700 Rosedale Avenue, St. Louis, MO, 63112, USA.
| | - Ketra Rice
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Highway, N.E., MS F-76, Atlanta, GA, 30341, USA.
| | - Lindsay Gressard
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Highway, N.E., MS F-76, Atlanta, GA, 30341, USA.
| |
Collapse
|
84
|
Siegl EJ, Miller JW, Khan K, Harris SE. Quality assurance through quality improvement and professional development in the National Breast and Cervical Cancer Early Detection Program. Cancer 2014; 120 Suppl 16:2584-90. [PMID: 25099901 DOI: 10.1002/cncr.28822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/04/2014] [Indexed: 11/09/2022]
Abstract
Quality assurance (QA) is the process of providing evidence that the outcome meets the established standards. Quality improvement (QI), by contrast, is the act of methodically developing ways to meet acceptable quality standards and evaluating current processes to improve overall performance. In the case of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the desired outcome is the delivery of quality health care services to program clients. The NBCCEDP provides professional development to ensure that participating providers have current knowledge of evidence-based clinical standards regarding breast and cervical cancer screening and diagnosis and are monitoring women with abnormal screening results for timely follow-up. To assess the quality of clinical care provided to NBCCEDP clients, performance data are collected by NBCCEDP grantees and compared against predetermined Centers for Disease Control and Prevention (CDC) benchmarks known as Data Quality Indicator Guides. In this article, the authors describe 1) the development and use of indicators for QI in the NBCCEDP and 2) the professional development activities implemented to improve clinical outcomes. QA identifies problems, whereas QI systematically corrects them. The quality of service delivery and improved patient outcomes among NBCCEDP grantees has enhanced significantly because of continuous monitoring of performance and professional development. By using QA, NBCCEDP grantees can maximize the quality of patient screening, diagnostic services, and follow-up. Examples of grantee activities to maintain quality of care are also described in this report.
Collapse
Affiliation(s)
- Elvira J Siegl
- Michigan Breast and Cervical Cancer Control Program, Lansing, Michigan
| | | | | | | |
Collapse
|
85
|
Ekwueme DU, Subramanian S, Trogdon JG, Miller JW, Royalty JE, Li C, Guy GP, Crouse W, Thompson H, Gardner JG. Cost of services provided by the National Breast and Cervical Cancer Early Detection Program. Cancer 2014; 120 Suppl 16:2604-11. [PMID: 25099904 DOI: 10.1002/cncr.28816] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/06/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is the largest cancer screening program for low-income women in the United States. This study updates previous estimates of the costs of delivering preventive cancer screening services in the NBCCEDP. METHODS We developed a standardized web-based cost-assessment tool to collect annual activity-based cost data on screening for breast and cervical cancer in the NBCCEDP. Data were collected from 63 of the 66 programs that received funding from the Centers for Disease Control and Prevention during the 2006/2007 fiscal year. We used these data to calculate costs of delivering preventive public health services in the program. RESULTS We estimated the total cost of all NBCCEDP services to be $296 (standard deviation [SD], $123) per woman served (including the estimated value of in-kind donations, which constituted approximately 15% of this total estimated cost). The estimated cost of screening and diagnostic services was $145 (SD, $38) per women served, which represented 57.7% of the total cost excluding the value of in-kind donations. Including the value of in-kind donations, the weighted mean cost of screening a woman for breast cancer was $110 with an office visit and $88 without, the weighted mean cost of a diagnostic procedure was $401, and the weighted mean cost per breast cancer detected was $35,480. For cervical cancer, the corresponding cost estimates were $61, $21, $415, and $18,995, respectively. CONCLUSIONS These NBCCEDP cost estimates may help policy makers in planning and implementing future costs for various potential changes to the program.
Collapse
Affiliation(s)
- Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
86
|
Lofters AK, Ng R, Lobb R. Primary care physician characteristics associated with cancer screening: a retrospective cohort study in Ontario, Canada. Cancer Med 2014; 4:212-23. [PMID: 25430885 PMCID: PMC4329005 DOI: 10.1002/cam4.358] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022] Open
Abstract
Primary care physicians can serve as both facilitators and barriers to cancer screening, particularly for under-screened groups such as immigrant patients. The objective of this study was to inform physician-targeted interventions by identifying primary care physician characteristics associated with cancer screening for their eligible patients, for their eligible immigrant patients, and for foreign-trained physicians, for their eligible immigrant patients from the same world region. A population-based retrospective cohort study was performed, looking back 3 years from 31 December 2010. The study was performed in urban primary care practices in Ontario, Canada's largest province. A total of 6303 physicians serving 1,156,627 women eligible for breast cancer screening, 2,730,380 women eligible for cervical screening, and 2,260,569 patients eligible for colorectal screening participated. Appropriate breast screening was defined as at least one mammogram in the previous 2 years, appropriate cervical screening was defined as at least one Pap test in the previous 3 years, and appropriate colorectal screening as at least one fecal occult blood test in the previous 2 years or at least one colonoscopy or barium enema in the previous 10 years. Just fewer than 40% of physicians were female, and 26.1% were foreign trained. In multivariable analyses, physicians who attended medical schools in the Caribbean/Latin America, the Middle East/North Africa, South Asia, and Western Europe were less likely to screen their patients than Canadian graduates. South Asian-trained physicians were significantly less likely to screen South Asian women for cervical cancer than other foreign-trained physicians who were seeing region-congruent patients (adjusted odds ratio: 0.56 [95% confidence interval 0.32–0.98] versus physicians from the USA, Australia and New Zealand). South Asian patients were the most vulnerable to under-screening, and decreasing patient income quintile was consistently associated with lower likelihood of screening, although less so for immigrant patients. This study highlights certain physician characteristics that are associated with cancer screening for eligible patients, including immigrant patients, and that should be considered when designing physician-targeted interventions. We have also highlighted an ethnic community, South Asians, which requires particular attention, both among its patients and its primary care providers. Future research should further explore the reasons for these findings.
Collapse
Affiliation(s)
- Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | |
Collapse
|
87
|
Maxwell AE, Hannon PA, Escoffery C, Vu T, Kohn M, Vernon SW, DeGroff A. Promotion and provision of colorectal cancer screening: a comparison of colorectal cancer control program grantees and nongrantees, 2011-2012. Prev Chronic Dis 2014; 11:E170. [PMID: 25275807 PMCID: PMC4184085 DOI: 10.5888/pcd11.140183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Since 2009, the Centers for Disease Control and Prevention (CDC) has awarded nearly $95 million to 29 states and tribes through the Colorectal Cancer Control Program (CRCCP) to fund 2 program components: 1) providing colorectal cancer (CRC) screening to uninsured and underinsured low-income adults and 2) promoting population-wide CRC screening through evidence-based interventions identified in the Guide to Community Preventive Services (Community Guide). CRCCP is a new model for disseminating and promoting use of evidence-based interventions. If the program proves successful, CDC may adopt the model for future cancer control programs. The objective of our study was to compare the colorectal cancer screening practices of recipients of CRCCP funding (grantees) with those of nonrecipients (nongrantees). METHODS We conducted parallel Web-based surveys in 2012 with CRCCP grantees (N = 29) and nongrantees (N = 24) to assess promotion and provision of CRC screening, including the use of evidence-based interventions. RESULTS CRCCP grantees were significantly more likely than nongrantees to use Community Guide-recommended evidence-based interventions (mean, 3.14 interventions vs 1.25 interventions, P < .001) and to use patient navigation services (eg, transportion or language translation services) (72% vs 17%, P < .001) for promoting CRC screening. Both groups were equally likely to use other strategies. CRCCP grantees were significantly more likely to provide CRC screening than were nongrantees (100% versus 50%, P < .001). CONCLUSION Results suggest that CRCCP funding and support increases use of evidence-based interventions to promote CRC screening, indicating the program's potential to increase population-wide CRC screening rates.
Collapse
Affiliation(s)
- Annette E Maxwell
- University of California at Los Angeles, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900. E-mail:
| | | | | | - Thuy Vu
- University of Washington, Seattle, Washington
| | | | - Sally W Vernon
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
88
|
Halterman JS, Fagnano M, Tremblay PJ, Fisher SG, Wang H, Rand C, Szilagyi P, Butz A. Prompting asthma intervention in Rochester-uniting parents and providers (PAIR-UP): a randomized trial. JAMA Pediatr 2014; 168:e141983. [PMID: 25288141 PMCID: PMC4232370 DOI: 10.1001/jamapediatrics.2014.1983] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A disproportionate number of impoverished and minority children have asthma and receive suboptimal preventive care. OBJECTIVE To evaluate whether the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers (PAIR-UP) intervention, administered in primary care offices, improves the delivery of preventive care and reduces morbidity for urban children with asthma. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial in which 12 urban primary care practices were matched based on size and type and randomly allocated to the PAIR-UP intervention or usual care (UC). We enrolled 638 children aged 2 to 12 years with persistent or poorly controlled asthma in the waiting room prior to a visit with a clinician for any reason from October 2009 to January 2013. Blinded interviewers called caregivers within 2 weeks to inquire about preventive measures taken at the visit and called them 2 and 6 months later to assess symptoms. INTERVENTIONS Children enrolled at PAIR-UP practices received prompts for the caregiver and clinician at the time of the visit that outlined the child's asthma severity or control as well as specific guideline-based recommendations to enhance preventive care. These practices also received educational resources and periodic feedback on their asthma care performance. The UC practices received copies of the asthma guidelines. MAIN OUTCOMES AND MEASURES The primary outcome was symptom-free days (SFDs) per 2 weeks at the 2-month follow-up. RESULTS We enrolled 638 children (participation rate of 80%; 36% were black, 36% were Hispanic, and 68% had Medicaid insurance). Groups were similar in demographic characteristics and asthma severity at baseline. At the index visit, more children in the PAIR-UP group received a preventive medication action (new medication, increased dose, recommendation to restart preventive medication) than in the UC group (58% vs 33%; odds ratio [OR] = 2.8; 95% CI, 1.9 to 3.9). More children in the PAIR-UP group than in the UC group received an asthma action plan (61% vs 23%; OR = 8.3; 95% CI, 3.7 to 18.7), discussions regarding asthma (93% vs 78%; OR = 4.5; 95% CI, 2.8 to 7.2), and secondhand smoke counseling (80% vs 63%; OR = 2.6; 95% CI, 1.2 to 5.5). At the 2-month follow-up, children in the PAIR-UP group had more SFDs per 2 weeks than those in the UC group (mean difference, 0.78 days; 95% CI, 0.29 to 1.27). At 6 months, the improvement in SFDs was no longer statistically significant (mean difference, 0.56; 95% CI, -0.14 to 1.25). CONCLUSIONS AND RELEVANCE The PAIR-UP intervention improved the delivery of preventive asthma care and reduced asthma morbidity for high-risk urban children with persistent asthma at 2 months, but the improvement in SFDs was no longer significant at 6 months. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01105754.
Collapse
Affiliation(s)
- Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Paul J. Tremblay
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Susan G. Fisher
- Department of Clinical Sciences, Temple University, Philadelphia, PA
| | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Cynthia Rand
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Peter Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Arlene Butz
- Pediatrics, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
89
|
Robinson MN, Tansil KA, Elder RW, Soler RE, Labre MP, Mercer SL, Eroglu D, Baur C, Lyon-Daniel K, Fridinger F, Sokler LA, Green LW, Miller T, Dearing JW, Evans WD, Snyder LB, Kasisomayajula Viswanath K, Beistle DM, Chervin DD, Bernhardt JM, Rimer BK. Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review. Am J Prev Med 2014; 47:360-71. [PMID: 25145620 DOI: 10.1016/j.amepre.2014.05.034] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/05/2014] [Accepted: 05/28/2014] [Indexed: 11/26/2022]
Abstract
CONTEXT Health communication campaigns including mass media and health-related product distribution have been used to reduce mortality and morbidity through behavior change. The intervention is defined as having two core components reflecting two social marketing principles: (1) promoting behavior change through multiple communication channels, one being mass media, and (2) distributing a free or reduced-price product that facilitates adoption and maintenance of healthy behavior change, sustains cessation of harmful behaviors, or protects against behavior-related disease or injury. EVIDENCE ACQUISITION Using methods previously developed for the Community Guide, a systematic review (search period, January 1980-December 2009) was conducted to evaluate the effectiveness of health communication campaigns that use multiple channels, including mass media, and distribute health-related products. The primary outcome of interest was use of distributed health-related products. EVIDENCE SYNTHESIS Twenty-two studies that met Community Guide quality criteria were analyzed in 2010. Most studies showed favorable behavior change effects on health-related product use (a median increase of 8.4 percentage points). By product category, median increases in desired behaviors ranged from 4.0 percentage points for condom promotion and distribution campaigns to 10.0 percentage points for smoking-cessation campaigns. CONCLUSIONS Health communication campaigns that combine mass media and other communication channels with distribution of free or reduced-price health-related products are effective in improving healthy behaviors. This intervention is expected to be applicable across U.S. demographic groups, with appropriate population targeting. The ability to draw more specific conclusions about other important social marketing practices is constrained by limited reporting of intervention components and characteristics.
Collapse
Affiliation(s)
- Maren N Robinson
- Community Guide Branch, Division of Epidemiology, Analysis and Library Services, Center for Surveillance, Epidemiology and Laboratory Services , CDC, Atlanta
| | - Kristin A Tansil
- Community Guide Branch, Division of Epidemiology, Analysis and Library Services, Center for Surveillance, Epidemiology and Laboratory Services , CDC, Atlanta
| | - Randy W Elder
- Community Guide Branch, Division of Epidemiology, Analysis and Library Services, Center for Surveillance, Epidemiology and Laboratory Services , CDC, Atlanta.
| | - Robin E Soler
- Community Guide Branch, Division of Epidemiology, Analysis and Library Services, Center for Surveillance, Epidemiology and Laboratory Services , CDC, Atlanta
| | - Magdala P Labre
- Community Guide Branch, Division of Epidemiology, Analysis and Library Services, Center for Surveillance, Epidemiology and Laboratory Services , CDC, Atlanta
| | - Shawna L Mercer
- Community Guide Branch, Division of Epidemiology, Analysis and Library Services, Center for Surveillance, Epidemiology and Laboratory Services , CDC, Atlanta
| | - Dogan Eroglu
- Office of Associate Director of Communications, Office of the Director, CDC, Atlanta
| | - Cynthia Baur
- Office of Associate Director of Communications, Office of the Director, CDC, Atlanta
| | - Katherine Lyon-Daniel
- Office of Associate Director of Communications, Office of the Director, CDC, Atlanta
| | - Fred Fridinger
- Office of Associate Director of Communications, Office of the Director, CDC, Atlanta
| | - Lynn A Sokler
- Office of Associate Director of Communications, Office of the Director, CDC, Atlanta
| | | | - Therese Miller
- Agency for Healthcare Research and Quality, Rockville, MD
| | | | | | | | | | - Diane M Beistle
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta
| | | | | | - Barbara K Rimer
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | |
Collapse
|
90
|
Yehia BR, Herati RS, Fleishman JA, Gallant JE, Agwu AL, Berry SA, Korthuis PT, Moore RD, Metlay JP, Gebo KA. Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts. PLoS One 2014; 9:e102766. [PMID: 25032989 PMCID: PMC4102540 DOI: 10.1371/journal.pone.0102766] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/21/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Guidelines recommend hepatitis C virus (HCV) screening for all people living with HIV (PLWH). Understanding HCV testing practices may improve compliance with guidelines and can help identify areas for future intervention. METHODS We evaluated HCV screening and unnecessary repeat HCV testing in 8,590 PLWH initiating care at 12 U.S. HIV clinics between 2006 and 2010, with follow-up through 2011. Multivariable logistic regression examined the association between patient factors and the outcomes: HCV screening (≥1 HCV antibody tests during the study period) and unnecessary repeat HCV testing (≥1 HCV antibody tests in patients with a prior positive test result). RESULTS Overall, 82% of patients were screened for HCV, 18% of those screened were HCV antibody-positive, and 40% of HCV antibody-positive patients had unnecessary repeat HCV testing. The likelihood of being screened for HCV increased as the number of outpatient visits rose (adjusted odds ratio 1.02, 95% confidence interval 1.01-1.03). Compared to men who have sex with men (MSM), patients with injection drug use (IDU) were less likely to be screened for HCV (0.63, 0.52-0.78); while individuals with Medicaid were more likely to be screened than those with private insurance (1.30, 1.04-1.62). Patients with heterosexual (1.78, 1.20-2.65) and IDU (1.58, 1.06-2.34) risk compared to MSM, and those with higher numbers of outpatient (1.03, 1.01-1.04) and inpatient (1.09, 1.01-1.19) visits were at greatest risk of unnecessary HCV testing. CONCLUSIONS Additional efforts to improve compliance with HCV testing guidelines are needed. Leveraging health information technology may increase HCV screening and reduce unnecessary testing.
Collapse
Affiliation(s)
- Baligh R Yehia
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ramin S Herati
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - John A Fleishman
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland, United States of America
| | - Joel E Gallant
- Southwest Care Center, Santa Fe, New Mexico, United States of America
| | - Allison L Agwu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Stephen A Berry
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - P Todd Korthuis
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, United States of America
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Joshua P Metlay
- General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| |
Collapse
|
91
|
Escoffery C, Rodgers KC, Kegler MC, Ayala M, Pinsker E, Haardörfer R. A grey literature review of special events for promoting cancer screenings. BMC Cancer 2014; 14:454. [PMID: 24942822 PMCID: PMC4082274 DOI: 10.1186/1471-2407-14-454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 06/10/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cancer remains the second leading cause of mortality in the United States. Special events such as health fairs, screening days or cultural festivals are employed often for community education about cancer screening. A previous systematic review of the published literature was conducted in 2012-2013. The purpose of this study was to conduct a grey literature component of special events that promote breast, cervical and colorectal cancer screening in the U.S. METHODS We conducted a grey literature search of dissertations/theses and conference abstracts. The theses/dissertations were restricted to those: 1) written in English, 2) published from January 1990 to December 2011, 3) examined at least one of the predefined categories of special events, 4) involved cancer screening for breast, cervical, and/or colorectal cancer, 5) included outcome data, and 6) conducted in the United States. A review of U.S. public health and cancer conference abstracts, that were readily available and had focused on at least of 3 cancer types and included outcome data, was conducted. Data were abstracted on the purpose, location, primary audience(s), activities conducted, screening provided onsite or referrals, and evaluation results. RESULTS The grey literature review found 6 special events. The types of events found added to the numbers found in the systematic review, especially receptions or parties and cultural festivals/events. All focused on increasing breast and cervical cancer screening except one that focused on breast cancer only. The reach of these events was targeted at mostly minorities or underserved communities. Common evidence-based strategies were group education, small media, and reducing structural barriers. Group education involved presentations from physicians, lay-health advisors, or cancer survivors, while reducing structural barriers included activities such as providing screening appointment sign-ups at the event or providing transportation for event participants. Mammogram screening rates ranged from 6.8% to 60% and Pap tests from 52% to 70%. CONCLUSIONS Further evaluation of special events to promote cancer screening will prove their effectiveness. A grey literature review can augment a systematic review of published literature. Additional data about these events through the grey literature offered additional insights into the goals, intervention components and outcomes of interventions.
Collapse
Affiliation(s)
- Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Road, 5th Floor, Atlanta, GA 30322, USA.
| | | | | | | | | | | |
Collapse
|
92
|
Gesink D, Mihic A, Antal J, Filsinger B, Racey CS, Perez DF, Norwood T, Ahmad F, Kreiger N, Ritvo P. Who are the under- and never-screened for cancer in Ontario: a qualitative investigation. BMC Public Health 2014; 14:495. [PMID: 24885998 PMCID: PMC4229738 DOI: 10.1186/1471-2458-14-495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/14/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Observed breast, cervical and colon cancer screening rates are below provincial targets for the province of Ontario, Canada. The populations who are under- or never-screened for these cancers have not been described at the Ontario provincial level. Our objective was to use qualitative methods of inquiry to explore who are the never- or under-screened populations of Ontario. METHODS Qualitative data were collected from two rounds of focus group discussions conducted in four communities selected using maps of screening rates by dissemination area. The communities selected were archetypical of the Ontario context: urban, suburban, small city and rural. The first phase of focus groups was with health service providers. The second phase of focus groups was with community members from the under- and never-screened population. Guided by a grounded theory methodology, data were collected and analyzed simultaneously to enable the core and related concepts about the under- and never-screened to emerge. RESULTS The core concept that emerged from the data is that the under- and never-screened populations of Ontario are characterized by diversity. Group level characteristics of the under- and never-screened included: 1) the uninsured (e.g., Old Order Mennonites and illegal immigrants); 2) sexual abuse survivors; 3) people in crisis; 4) immigrants; 5) men; and 6) individuals accessing traditional, alternative and complementary medicine for health and wellness. Under- and never-screened could have one or multiple group characteristics. CONCLUSION The under- and never-screened in Ontario comprise a diversity of groups. Heterogeneity within and intersectionality among under- and never-screened groups adds complexity to cancer screening participation and program planning.
Collapse
Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
93
|
Escoffery C, Rodgers KC, Kegler MC, Haardörfer R, Howard DH, Liang S, Pinsker E, Roland KB, Allen JD, Ory MG, Bastani R, Fernandez ME, Risendal BC, Byrd TL, Coronado GD. A systematic review of special events to promote breast, cervical and colorectal cancer screening in the United States. BMC Public Health 2014; 14:274. [PMID: 24661503 PMCID: PMC3987802 DOI: 10.1186/1471-2458-14-274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/06/2014] [Indexed: 12/03/2022] Open
Abstract
Background Special events are common community-based strategies for health promotion. This paper presents findings from a systematic literature review on the impact of special events to promote breast, cervical or colorectal cancer education and screening. Methods Articles in English that focused on special events involving breast, cervical, and/or colorectal cancer conducted in the U.S. and published between January 1990 and December 2011 were identified from seven databases: Ovid, Web of Science, CINAHL, PsycINFO, Sociological Abstract, Cochrane Libraries, and EconLit. Study inclusion and data extraction were independently validated by two researchers. Results Of the 20 articles selected for screening out of 1,409, ten articles on special events reported outcome data. Five types of special events were found: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. Reach ranged from 50–1732 participants. All special events used at least one evidence-based strategy suggested by the Community Guide to Preventive Services, such as small media, one-on-one education, and reducing structural barriers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening. Conclusions Special events found in the review varied and used evidence-based strategies. Screening data suggest that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening. The heterogeneity of populations served, event activities, outcome variables assessed, and the reliance on self-report to measure screening limit conclusions. This study highlights the need for further research to determine the effectiveness of special events to increase cancer screening.
Collapse
Affiliation(s)
- Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
94
|
Greaney ML, De Jesus M, Sprunck-Harrild KM, Tellez T, Bastani R, Battaglia TA, Michaelson JS, Emmons KM. Designing audience-centered interactive voice response messages to promote cancer screenings among low-income Latinas. Prev Chronic Dis 2014; 11:E40. [PMID: 24625364 PMCID: PMC3958144 DOI: 10.5888/pcd11.130213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cancer screening rates among Latinas are suboptimal. The objective of this study was to explore how Latinas perceive cancer screening and the use and design of interactive voice response (IVR) messages to prompt scheduling of 1 or more needed screenings. METHODS Seven focus groups were conducted with Latina community health center patients (n = 40) in need of 1 or more cancer screenings: 5 groups were of women in need of 1 cancer screening (breast, cervical, or colorectal), and 2 groups were of women in need of multiple screenings. A bilingual researcher conducted all focus groups in Spanish using a semistructured guide. Focus groups were recorded, transcribed, and translated into English for analysis. Emergent themes were identified by using thematic content analysis. RESULTS Participants were familiar with cancer screening and viewed it positively, although barriers to screening were identified (unaware overdue for screening, lack of physician referral, lack of insurance or insufficient insurance coverage, embarrassment or fear of screening procedures, fear of screening outcomes). Women needing multiple screenings voiced more concern about screening procedures, whereas women in need of a single screening expressed greater worry about the screening outcome. Participants were receptive to receiving IVR messages and believed that culturally appropriate messages that specified needed screenings while emphasizing the benefit of preventive screening would motivate them to schedule needed screenings. CONCLUSION Participants' receptiveness to IVR messages suggests that these messages may be an acceptable strategy to promote cancer screening among underserved Latina patients. Additional research is needed to determine the effectiveness of IVR messages in promoting completion of cancer screening.
Collapse
Affiliation(s)
- Mary L Greaney
- Department of Kinesiology, 25 West Independence Way, University of Rhode Island, Kingston, RI 02881. E-mail:
| | - Maria De Jesus
- Center on Health, Risk, and Society and School of International Service, American University, Washington, DC
| | - Kim M Sprunck-Harrild
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Trinidad Tellez
- New Hampshire Department of Health and Human Services, Concord, New Hampshire
| | - Roshan Bastani
- University of California Los Angeles School of Public Health, Los Angeles, California
| | - Tracy A Battaglia
- Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - James S Michaelson
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen M Emmons
- Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, Massachusetts
| |
Collapse
|
95
|
Benard VB, Saraiya M, Greek A, Hawkins NA, Roland KB, Manninen D, Ekwueme DU, Miller JW, Unger ER. Overview of the CDC Cervical Cancer (Cx3) Study: an educational intervention of HPV testing for cervical cancer screening. J Womens Health (Larchmt) 2014; 23:197-203. [PMID: 24380501 PMCID: PMC4386595 DOI: 10.1089/jwh.2013.4655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The recommended screening interval when using the Papanicolaou (Pap) and human papillomavirus (HPV) test (co-testing) is 5 years. However because providers are reluctant to extend the screening interval, we launched a study to identify barriers to appropriate use of the co-test and to implement an educational intervention to promote evidence-based screening practices. This article provides an overview of the study including the multi-component intervention and participant demographics. METHODS The study was conducted in 15 clinics associated with 6 Federally Qualified Health Centers (FQHCs) in Illinois. Each clinic received HPV tests to administer with routine Pap tests among enrolled patients (n=2,246) and was assigned to a study arm: intervention arm (n=7) received a multi-component educational intervention (small media, academic detailing, and website) for providers and printed educational materials for patients, and control arm (n=8) received printed copies of general guidelines. Clinic coordinators (n=15), providers (n=98), and patients (n=984) completed baseline surveys to assess screening practices. RESULTS Providers reported an average age of 41.3 years and were predominately female, non-Hispanic, and white. Patients reported an average age of 45.0 years and nearly two-thirds were Hispanic or black. Of the 2,246 patients, 89% had a normal co-test. Lessons learned from the study included the importance of buy-in at a high level in the organization, a champion provider, and a clinical coordinator devoted to the study. CONCLUSION Materials from this study can be adapted to educate providers and patients on appropriate use of the co-test and encourage extended screening intervals as a safe and effective practice.
Collapse
Affiliation(s)
- Vicki B. Benard
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - April Greek
- Battelle, Health & Analytics, Seattle, Washington
| | | | | | | | | | | | | |
Collapse
|
96
|
DeJesus R. Capsule commentary on Yoong et al., a cross-sectional study examining Australian general practitioners' identification of overweight and obese patients. J Gen Intern Med 2014; 29:359. [PMID: 24150597 PMCID: PMC3912301 DOI: 10.1007/s11606-013-2671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ramona DeJesus
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA,
| |
Collapse
|
97
|
Get screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening. J Gen Intern Med 2014; 29:90-7. [PMID: 24002626 PMCID: PMC3889981 DOI: 10.1007/s11606-013-2586-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments. OBJECTIVE To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice. DESIGN Pragmatic randomized trial. PARTICIPANTS Men and women aged 50-74 years past due for CRC screen and women aged 40-74 years past due for BC screening. INTERVENTIONS We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call). MAIN MEASURES Documentation of mammography or colorectal cancer screening at 52 weeks following randomization. KEY RESULTS Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2-4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1-3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1-3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0-3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates. CONCLUSIONS The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.
Collapse
|
98
|
Roman L, Meghea C, Ford S, Penner L, Hamade H, Estes T, Williams KP. Individual, provider, and system risk factors for breast and cervical cancer screening among underserved Black, Latina, and Arab women. J Womens Health (Larchmt) 2014; 23:57-64. [PMID: 24283674 PMCID: PMC4056454 DOI: 10.1089/jwh.2013.4397] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Socioeconomic and racial/ethnic disparities in breast and cervical cancer screening persist. An exploratory study was conducted to better understand co-occurring risk factors in underserved groups that could inform interventions to improve screening adherence. The objective of this study was to examine associations between breast and cervical cancer screening adherence and co-occurring risk factors in three racial/ethnic groups of underserved women. METHODS Black, Latina, and Arab women (N=514), ages 21 to 70 years, were enrolled into the Kin Keeper(SM) randomized controlled trial in communities around Detroit, Michigan. We used participant baseline assessments (e.g., demographic characteristics, health literacy) to explore screening risks using an additive approach and multivariate logistic analyses. RESULTS For black women, having more health literacy risks were associated with reduced odds of a clinical breast exam (CBE), mammogram, and Papanicolaou (Pap) test; more competing priorities were associated with reduced odds of a Pap test; lack of doctor mammogram recommendation was significantly associated with decreased odds of CBE. For Latina women, lack of doctor recommendations were significantly associated with decreased odds of CBE, mammogram, and Pap test. For Arab women, lack of doctor recommendations were significantly associated with decreased odds of CBE, mammogram, and Pap test; more competing priorities were significantly associated with reduced odds of CBE and Pap test. All results were significant at p<0.05. CONCLUSIONS Characteristics associated with breast and cervical screening adherence differs among Black, Latina, and Arab underserved women. Interventions to improve screening should be tailored for racial/ethnic groups with particular attention to competing survival priorities, health literacy risks factors, and provider recommendations.
Collapse
Affiliation(s)
- LeeAnne Roman
- Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
| | - Cristian Meghea
- Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
- Institute for Health Policy, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Sabrina Ford
- Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
| | - Louis Penner
- Karmanos Cancer Institute, Communication and Behavioral Oncology, Detroit, Michigan
| | - Hiam Hamade
- Arab Community Center for Economic and Social Services (ACCESS), Dearborn, Michigan
| | - Tamika Estes
- Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
| | - Karen Patricia Williams
- Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
| |
Collapse
|
99
|
Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn M, Leeman J, Carvalho ML, Pfeiffer DJ, Dwyer A, Fernandez ME, Vernon SW, Liang L, DeGroff A. Colorectal Cancer Control Program grantees' use of evidence-based interventions. Am J Prev Med 2013; 45:644-8. [PMID: 24139779 PMCID: PMC4618374 DOI: 10.1016/j.amepre.2013.06.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/14/2013] [Accepted: 06/25/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is recommended for adults aged 50-75 years, yet screening rates are low, especially among the uninsured. The CDC initiated the Colorectal Cancer Control Program (CRCCP) in 2009 with the goal of increasing CRC screening rates to 80% by 2014. A total of 29 grantees (states and tribal organizations) receive CRCCP funding to (1) screen uninsured adults and (2) promote CRC screening at the population level. PURPOSE CRCCP encourages grantees to use one or more of five evidence-based interventions (EBIs) recommended by the Guide to Community Preventive Services. The purpose of the study was to evaluate grantees' EBI use. METHODS A web-based survey was conducted in 2011 measuring grantees' use of CRC screening EBIs and identifying their implementation partners. Data were analyzed in 2012. RESULTS Twenty-eight grantees (97%) completed the survey. Most respondents (96%) used small media. Fewer used client reminders (75%); reduction of structural barriers (50%); provider reminders (32%); or provider assessment and feedback (50%). Provider-oriented EBIs were rated as harder to implement than client-oriented EBIs. Grantees partnered with several types of organizations to implement EBIs, many with county- or state-wide reach. CONCLUSIONS Almost all grantees implement EBIs to promote CRC screening, but the EBIs that may have the greatest impact with CRC screening are implemented by fewer grantees in the first 2 years of the CRCCP.
Collapse
Affiliation(s)
- Peggy A Hannon
- Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
100
|
Schichtel M, Rose PW, Sellers C. Educational interventions for primary healthcare professionals to promote the early diagnosis of cancer: a systematic review. EDUCATION FOR PRIMARY CARE 2013; 24:274-90. [PMID: 23906171 DOI: 10.1080/14739879.2013.11494186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Primary healthcare professionals seem to lack knowledge and skills in the area of diagnosing cancer which may lead to more advanced stage at diagnosis, poorer cancer survival figures and increased morbidity. The aim of this study was to examine the evidence of effectiveness of educational interventions for primary healthcare professionals to promote the early diagnosis of cancer. METHODS We searched bibliographic databases, the grey literature and reference lists for randomised controlled trials (RCTs) of educational interventions delivered at an individual clinician and practice level. RESULTS We found sufficient evidence that interactive education, computerised reminder systems and audit and feedback delivered to clinicians may significantly increase several cancer detection measures in the short term and some evidence that they promote early diagnosis. Whilst educational outreach and local opinion leaders had some effect, formal education alone seemed ineffectual. CONCLUSION Certain educational interventions delivered at a clinician as well as at a practice level may promote the early diagnosis of cancer in primary care. There is currently limited evidence for their long-term sustainability and effectiveness.
Collapse
|