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Bartholomew T, Colleoni M, Schmidt H. Financial incentives for breast cancer screening undermine informed choice. BMJ 2022; 376:e065726. [PMID: 35012959 DOI: 10.1136/bmj-2021-065726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Harald Schmidt
- Department of Medical Ethics and Health Policy, University of Pennsylvania, USA
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2
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Starbird LE, DiMaina C, Sun CA, Han HR. A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases. J Community Health 2020; 44:400-411. [PMID: 30206755 DOI: 10.1007/s10900-018-0572-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transportation is an important social determinant of health. Transportation barriers disproportionately affect the most vulnerable groups of society who carry the highest burden of chronic diseases; therefore, it is critical to identify interventions that improve access to transportation. We synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management. A systematic literature search of peer-reviewed studies that include an intervention with a transportation component was performed using three electronic databases-PubMed, EMBASE, and CINAHL-along with a hand-search. We screened 478 unique titles and abstracts. Two reviewers independently evaluated 41 full-text articles and 10 studies met eligibility criteria for inclusion. The transportation interventions included one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1). Transportation support was offered within multi-component interventions including counseling, care coordination, education, financial incentives, motivational interviewing, and navigation assistance. Community health/outreach workers (n = 3), nurses (n = 3), and research or clinic staff (n = 3) were the most common interventionists. Studies reported improvements in cancer screening rates, chronic disease management, hospital utilization, linkage and follow up to care, and maternal empathy. Overall, transportation is a well-documented barrier to engaging in chronic care among vulnerable populations. We found evidence suggesting transportation services offered in combination with other tailored services improves patient health outcomes; however, future research is warranted to examine the separate impact of transportation interventions that are tested within multi-component studies.
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Affiliation(s)
- Laura E Starbird
- Center for Health Policy, Columbia University School of Nursing, 560 W. 168th Street, New York, NY, 10032, USA.
| | - Caitlin DiMaina
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Chun-An Sun
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Hae-Ra Han
- Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Center for Community Innovation and Scholarship, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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3
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Madray V, Ginjupalli S, Hashmi O, Sams RW, Johnson JA, Stoff B. Access to dermatology services at free medical clinics: A nationwide cross-sectional survey. J Am Acad Dermatol 2019; 81:245-246. [DOI: 10.1016/j.jaad.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 11/26/2022]
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Paskett ED, Dudley D, Young GS, Bernardo BM, Wells KJ, Calhoun EA, Fiscella K, Patierno SR, Warren-Mears V, Battaglia TA. Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening. J Womens Health (Larchmt) 2015; 25:15-21. [PMID: 26625131 DOI: 10.1089/jwh.2014.5094] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE As part of the Patient Navigation Research Program, we examined the effect of patient navigation versus usual care on timely diagnostic follow-up, defined as clinical management for women with cervical abnormalities within accepted time frames. METHODS Participants from four Patient Navigation Research Program centers were divided into low- and high-risk abnormality groups and analyzed separately. Low-risk participants (n = 2088) were those who enrolled with an initial Pap test finding of atypical squamous cells of undetermined significance (ASCUS) with a positive high-risk human papillomavirus (HPV) serotype, atypical glandular cells, or low-grade squamous intraepithelial lesion (LGSIL). High-risk participants were those with an initial finding of high-grade squamous intraepithelial lesion (HGSIL) (n = 229). A dichotomous outcome of timely diagnostic follow-up within 180 days was used for the low-risk abnormality group and timely diagnostic follow-up within 60 days for the high-risk group, consistent with treatment guidelines. A logistic mixed-effects regression model was used to evaluate the intervention effect using a random effect for study arm within an institution. A backward selection process was used for multivariable model building, considering the impact of each predictor on the intervention effect. RESULTS Low-risk women in the patient navigation arm showed an improvement in the odds of timely diagnostic follow-up across all racial groups, but statistically significant effects were only observed in non-English-speaking Hispanics (OR 5.88, 95% CI 2.81-12.29). No effect was observed among high-risk women. CONCLUSION These results suggest that patient navigation can improve timely diagnostic follow-up among women with low-risk cervical abnormalities, particularly in non-English-speaking Hispanic women.
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Affiliation(s)
- Electra D Paskett
- 1 Division of Cancer Prevention and Control, Ohio State University , Columbus, Ohio.,2 Comprehensive Cancer Center, Ohio State University , Columbus, Ohio
| | - Donald Dudley
- 3 Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Gregory S Young
- 4 Center for Biostatistics, Ohio State University , Columbus, Ohio
| | | | - Kristen J Wells
- 5 Department of Psychology, San Diego State University , San Diego, California
| | - Elizabeth A Calhoun
- 6 Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago , Chicago, Illinois
| | - Kevin Fiscella
- 7 Division of Oncology, Department of Family Medicine, Community, and Preventive Medicine, James P. Wilmont Cancer Center, University of Rochester , Rochester, New York
| | - Steven R Patierno
- 8 George Washington University Cancer Institute , Washington, DC.,9 Duke Cancer Institute , Durham, North Carolina
| | - Victoria Warren-Mears
- 10 Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center , Portland, Oregon
| | - Tracy A Battaglia
- 11 Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine , Boston, Massachusetts
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Hui SKA, Miller SM, Wen KY, Fang Z, Li T, Buzaglo J, Hernandez E. Psychosocial barriers to follow-up adherence after an abnormal cervical cytology test result among low-income, inner-city women. J Prim Care Community Health 2014; 5:234-41. [PMID: 24718518 DOI: 10.1177/2150131914529307] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Low-income, inner-city women bear a disproportionate burden of cervical cancer in both incidence and mortality rates in the United States, largely because of low adherence to follow-up recommendations after an abnormal cervical cytology result in the primary care setting. The goals of the present study were to delineate the theory-based psychosocial barriers underlying these persistent low follow-up rates and their sociodemographic correlates. METHODS Guided by a well-validated psychosocial theory of health behaviors, this cross-sectional, correlational study assessed the barriers to follow-up adherence among underserved women (N = 210) who received an abnormal cervical cytology result. Participants were recruited through an inner-city hospital colposcopy clinic, and were assessed by telephone prior to the colposcopy appointment. RESULTS Participants were largely of African American race (82.2%), lower than high school completion education (58.7%), single, never married (67.3%), and without full-time employment (64.1%). Knowledge barriers were most often endorsed (68%, M = 3.22), followed by distress barriers (64%, M = 3.09), and coping barriers (36%, M = 2.36). Forty-six percent reported more than one barrier category. Less education and being unemployed were correlated with higher knowledge barriers (P < .0001 and P < .01, respectively) and more coping barriers (P < .05 and P < .05, respectively). Women who were younger than 30 years displayed greater distress barriers (P < .05). CONCLUSION In the primary care setting, assessing and addressing knowledge and distress barriers after feedback of an abnormal cervical cytology result may improve adherence to follow-up recommendations. The use of structured counseling protocols and referral to navigational and other resources may facilitate this process and thereby reduce disparities in cervical cancer.
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Affiliation(s)
- Siu-Kuen Azor Hui
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Suzanne M Miller
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Kuang-Yi Wen
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Zhu Fang
- Everest Clinical Research Services, Little Falls, NJ, USA
| | - Tianyu Li
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Joanne Buzaglo
- Research and Training Institute of Cancer Support Community, Philadelphia, PA, USA
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Park YS, Park JS. Predictors of Follow-up Screening in Women with Abnormal Pap Smears. ASIAN ONCOLOGY NURSING 2014. [DOI: 10.5388/aon.2014.14.2.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Young Suk Park
- Keimyung University Dongsan Medical Center, Daegu, Korea
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Percac-Lima S, Benner CS, Lui R, Aldrich LS, Oo SA, Regan N, Chabner BA. The impact of a culturally tailored patient navigator program on cervical cancer prevention in Latina women. J Womens Health (Larchmt) 2013; 22:426-31. [PMID: 23621746 DOI: 10.1089/jwh.2012.3900] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cervical cancer disproportionately affects Latina women in the United States. This study evaluated the impact of patient navigation on cervical cancer prevention in Latinas. METHODS Between January 2004 and April 2011, 533 Latina women with an abnormal Pap smear requiring colposcopy received patient navigation from their healthcare center in Chelsea, Massachusetts, to the Massachusetts General Hospital (MGH). The comparison group comprised 253 non-navigated Latinas from other primary care practices at MGH referred to the same MGH colposcopy clinic. Primary outcomes were the percentage of missed colposcopy appointments, time to colposcopy, and changes in the severity of cervical pathology at colposcopy over two time periods, 2004-2007 and 2008-2011. RESULTS The mean age in both groups was 35 years (range 22-86). Navigated women had fewer missed colposcopy appointments over time, with the average falling from 19.8% to 15.7% (p=0.024), compared with an insignificant increase in the no-show rates from 18.6% to 20.6% (p=0.454) in the comparison group. The difference in the no-show rate trend over time between the groups was significant (p<0.001). The time to colposcopy did not change in either group, though trends over time demonstrated a shorter follow-up for navigated women (p=0.010). The grade of cervical abnormality among navigated women decreased from a numerical score of 2.03 to 1.83 (p=0.035) over the two time intervals, while the severity of pathological score in the non-navigated group did not change significantly from 1.83 to 1.92 (p=0.573) in the same interval. Comparison of trends in pathological score over time showed a decrease in the severity of cervical abnormality for navigated participants compared to the non-navigated group (p<0.001). CONCLUSION Patient navigation can prevent cervical cancer in Latina women by increasing colposcopy clinic attendance, shortening time to colposcopy, and decreasing severity of cervical abnormalities over time.
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Affiliation(s)
- Sanja Percac-Lima
- Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, Massachusetts 02150, USA.
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8
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Low-Income Women with Abnormal Breast Findings: Results of a Randomized Trial to Increase Rates of Diagnostic Resolution. Cancer Epidemiol Biomarkers Prev 2010; 19:1927-36. [DOI: 10.1158/1055-9965.epi-09-0481] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mojica CM, Bastani R. Receipt of diagnostic tests for breast cancer: validity of self-reports among low-income, mostly latina, indigent women. Eval Health Prof 2010; 33:437-51. [PMID: 20457716 DOI: 10.1177/0163278710367802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the validity of self-reported completion of diagnostic testing after an abnormal breast cancer screening test. This study assesses the validity of self-reported diagnostic follow-up among 819 low-income, mostly Latina, indigent women with a breast abnormality at two public hospitals in Los Angeles County. Survey responses on receipt of a mammogram, ultrasound, fine needle aspiration, surgical biopsy, or clinical breast exam for diagnostic evaluation of the breast abnormality were compared to medical record data. The authors calculated concordance, Cohen's κ statistic, and sensitivity and specificity. Kappa values indicated slight agreement for mammogram, ultrasound, and clinical breast exam, and moderate agreement for fine needle aspiration and surgical biopsy. Sensitivity of self-reports was high for all tests; specificity was poor for all tests except surgical biopsy. Self-reports of receipt of diagnostic testing for a breast abnormality among low-income, mostly Latina, indigent women are not accurate when compared to medical records.
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Affiliation(s)
- Cynthia M Mojica
- Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, 78240, USA.
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Blomberg K, Forss A, Ternestedt BM, Tishelman C. From 'silent' to 'heard': professional mediation, manipulation and women's experiences of their body after an abnormal Pap smear. Soc Sci Med 2008; 68:479-86. [PMID: 19081661 DOI: 10.1016/j.socscimed.2008.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Indexed: 11/25/2022]
Abstract
While there is a large body of research on cervical cancer screening, fewer studies address the experiences of women receiving abnormal Pap smear results after routine screening. Those studies highlighting such experiences tend to concentrate on resulting psychosocial distress, with an absence in the literature about women's experiences of their bodies during medical follow-up for dysplasia, and no studies were found that explore such experiences over time. In this article, we focus on bodily experiences over time during medical follow-up of an abnormal Pap smear among a group of women in Sweden. This qualitative analysis is based on interview data from a total of 30 women, and with in-depth analysis of the content of 34 transcribed interviews with nine women who were followed longitudinally. We found that medical follow-up involved an experience of both "having" and "being" a body, which changed over time. Women described a process that ranged from having a cervix that was neither felt, 'heard', nor seen, to having a body that became known to them first indirectly through professional mediation and later through direct experience after professional manipulation. The conceptualization of bodily boundaries appeared to change, e.g. through visualization of the previously unfamiliar cervix, pain, vaginal discharge, and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Thus, bodily experiences appear to be an intrinsic part of medical follow-up of an abnormal Pap smear through which health, disease, and risks in the past, present, and future were reconceptualised.
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Affiliation(s)
- Karin Blomberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
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11
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Singhal R, Rubenstein LV, Wang M, Lee ML, Raza A, Holschneider CH. Variations in practice guideline adherence for abnormal cervical cytology in a county healthcare system. J Gen Intern Med 2008; 23:575-80. [PMID: 18286344 PMCID: PMC2324150 DOI: 10.1007/s11606-008-0528-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 08/02/2007] [Accepted: 01/16/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reduction in cervical cancer incidence and mortality is not only dependant on promoting cervical cancer screening but also on providing appropriate follow-up and treatment of abnormal cervical cytology. OBJECTIVES The objective of this study was to determine variations in guideline adherence for women requiring abnormal cervical cytology follow-up. SUBJECTS Subjects of the study are women 18 years or older with an abnormal Pap test in 2000 within a large county healthcare system (n = 8,571). MEASUREMENTS Guideline adherence was determined by the presence or absence of the appropriate follow-up procedure within an acceptable time interval for each degree of cytological abnormality. Patients with no follow-up studies were deemed to be lost to follow-up. RESULTS Of study subjects, 18.5% were lost to follow-up care. Of the remaining 6,987 women, 60.3% received optimal care, 9.4% received suboptimal care, and 30.3% received poor care. Follow-up rates were higher for patients with higher degree of cytological abnormality (OR, 1.29, 95% CI, 1.17-1.42), older patients (OR, 1.03, 95% CI, 1.02-1.030) and those receiving the index Pap test at a larger healthcare facility (OR, 1.13; 95% CI, 1.01-1.27). Receiving optimal care was positively correlated with higher degree of cytological abnormality (p < .0001) and larger facility size (p = .002). Regional variations in care demonstrated the largest cluster having the lowest lost to follow-up rate and the most optimal care. CONCLUSIONS A significant number of women with abnormal cervical cytology are receiving less than optimal care. Further studies are required to determine the specific healthcare delivery practices that need to be targeted to improve guideline adherence for follow-up of abnormal cytology.
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Affiliation(s)
- Rita Singhal
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA.
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12
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Eggleston KS, Coker AL, Luchok KJ, Meyer TE. Adherence to recommendations for follow-up to abnormal Pap tests. Obstet Gynecol 2007; 109:1332-41. [PMID: 17540805 DOI: 10.1097/01.aog.0000266396.25244.68] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether timely adherence rates differ by race among women with abnormal Pap tests participating in a cost-free or reduced-cost program. METHODS Eligible subjects included women aged 47-64 years who received a referral for follow-up care after an abnormal Pap test from 1999 to 2002 in South Carolina (n=330). Adherence was measured as days to receipt of follow-up care after an abnormal Pap test. Cox proportional hazards modeling was used to estimate risk factors associated with time to adherence within 60 and 365 days by race. RESULTS African-American and non-Hispanic white women had similar adherence to follow-up. Among white women, those with high-grade lesions were less likely to adhere in a timely manner relative to those with low-grade lesions (hazard ratio 0.6, 95% confidence interval [CI] 0.4-1.0). For African-American women, rural residence (hazard ratio: 0.5, 95% CI 0.2-0.9) and history of abnormal Pap tests (hazard ratio 0.6, 95% CI 0.3-1.0) were associated with decreased adherence, whereas less education (hazard ratio 2.3, 95% CI 1.3-3.9) was associated with increased adherence. CONCLUSION Adherence rates do not differ by race. However, risk factors for adherence within race are variable. Interventions tailored to the differential needs of racial and ethnic groups may prove effective toward increasing timely adherence rates. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Katherine S Eggleston
- University of Texas Health Science Center, School of Public Health, Houston, Texas 77025, USA.
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Eggleston KS, Coker AL, Das IP, Cordray ST, Luchok KJ. Understanding Barriers for Adherence to Follow-Up Care for Abnormal Pap Tests. J Womens Health (Larchmt) 2007; 16:311-30. [PMID: 17439377 DOI: 10.1089/jwh.2006.0161] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Approximately 4000 women annually will die from preventable and treatable cervical cancer. Failure to adhere to follow-up recommendations after an abnormal Pap test can lead to development of cervical cancer. This paper summarizes the body of literature on adherence to follow-up after an abnormal Pap test in order to facilitate development of interventions to decrease morbidity and mortality due to cervical cancer. METHODS We conducted a comprehensive search of published literature addressing risk factors for adherence or interventions to improve adherence following an abnormal Pap test as the outcome. We included peer-reviewed original research conducted in the United States from 1990 to 2005. RESULTS Fourteen analytical and twelve experimental studies that met our criteria were reviewed. Lesion severity and health beliefs were consistently associated with adherence rates. Communication interventions, including telephone reminders, counseling, and educational sessions, increased follow-up compliance across intervention studies. Inconsistent evidence for associations among race, income, and age were found. CONCLUSIONS Further research is needed to reinforce current studies addressing health beliefs and social support. Interventions that focus on the interplay among psychological, educational, and communication barriers are necessary. These interventions should be adapted and applied across various racial/ethnic and socioeconomic groups to reach all women with a high-risk profile for invasive cervical cancer.
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Affiliation(s)
- Katherine S Eggleston
- University of Texas Health Science Center, School of Public Health, Houston, Texas 77025, USA.
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Moore CR, Lin JJ, O'Connor N, Halm EA. Follow-up of markedly elevated serum potassium results in the ambulatory setting: implications for patient safety. Am J Med Qual 2006; 21:115-24. [PMID: 16533903 DOI: 10.1177/1062860605285047] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Failure to follow up outpatient test results in a timely manner is a growing patient safety concern. To investigate the follow-up of markedly elevated serum potassium levels in the ambulatory setting, the authors reviewed the medical records of all patients seen in a large primary care practice between September 1, 2003, and August 31, 2004, with potassium levels > or = 5.8 mEq/L. Of the 12,914 serum potassium tests performed, there were 109 cases of markedly elevated serum potassium levels in 86 patients. The median potassium level was 5.9 mEq/L (range, 5.8-7.3). More than half the patients were recalled to the clinic specifically for repeat testing; however, 25% of patients had no repeat tests until they were seen at routine follow-up visits. The median time to a repeat potassium level was 6 days (range, 0-445). Patients > or = 65 years old had a lower likelihood of having repeat testing within 1 week (odds ratio = 0.38, P = .03).
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Affiliation(s)
- Carlton R Moore
- Division of General Internal Medicine, Mount Sinai School of Medicine, 1470 Madison Avenue, New York, NY 10029, USA.
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15
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Engelstad LP, Stewart S, Otero-Sabogal R, Leung MS, Davis PI, Pasick RJ. The effectiveness of a community outreach intervention to improve follow-up among underserved women at highest risk for cervical cancer. Prev Med 2005; 41:741-8. [PMID: 16125761 DOI: 10.1016/j.ypmed.2005.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Revised: 06/06/2005] [Accepted: 06/17/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND A disproportionate number of women diagnosed with cervical cancer are from low-income and/or ethnically diverse groups. This study was designed to evaluate the effectiveness of an outreach and counseling intervention at improving the rate of follow-up of abnormal Pap smears among women at Alameda County Medical Center, Oakland, CA. METHODS Between September 1, 1999 and August 31, 2001, 348 women with abnormal Pap test results were randomly assigned to intervention or usual care. The main outcome was rate of follow-up. RESULTS The intervention produced a significant increase in the rate of follow-up visits within 6 months. Women in the intervention group were much more likely to obtain timely follow-up at Highland Hospital than were those in the control group (61% vs. 32%, P = 0.001). The intervention was equally effective when delivered to women in the control group who had no follow-up by 6 months. Overall, we were able to contact 90% of women in the intervention group. CONCLUSIONS An outreach intervention is highly effective at increasing follow-up of abnormal Pap smears in a public hospital setting. Institutions offering cervical cancer screening to low-income, high-risk women should consider the use of outreach workers to reduce loss to follow-up.
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Affiliation(s)
- Linda P Engelstad
- Alameda County Medical Center, 1411 East 31st Street, Oakland, CA 94602, USA.
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Kane RL, Johnson PE, Town RJ, Butler M. A structured review of the effect of economic incentives on consumers' preventive behavior. Am J Prev Med 2004; 27:327-52. [PMID: 15488364 DOI: 10.1016/j.amepre.2004.07.002] [Citation(s) in RCA: 181] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Improving participation in preventive activities will require finding methods to encourage consumers to engage in and remain in such efforts. This review assesses the effects of economic incentives on consumers' preventive health behaviors. A study was classified as complex preventive health if a sustained behavior change was required of the consumer; if it could be accomplished directly (e.g., immunizations), it was considered simple. A systematic literature review identified 111 randomized controlled trials of which 47 (published between 1966 and 2002) met the criteria for review. The economic incentives worked 73% of the time (74% for simple, and 72% for complex). Rates varied by the goal of the incentive. Incentives that increased ability to purchase the preventive service worked better than more diffuse incentives, but the type matters less than the nature of the incentive. Economic incentives are effective in the short run for simple preventive care, and distinct, well-defined behavioral goals. Small incentives can produce finite changes, but it is not clear what size of incentive is needed to yield a major sustained effect.
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Affiliation(s)
- Robert L Kane
- Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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17
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Bastani R, Yabroff KR, Myers RE, Glenn B. Interventions to improve follow-up of abnormal findings in cancer screening. Cancer 2004; 101:1188-200. [PMID: 15316914 PMCID: PMC1811062 DOI: 10.1002/cncr.20506] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The potential reduction in morbidity and mortality through cancer screening cannot be realized without receipt of appropriate follow-up care for abnormalities identified via screening. In this paper, the authors critically examine the existing literature on correlates of receipt of appropriate follow-up care for screen-detected abnormalities, as well as the literature on interventions designed to increase rates of receipt of follow-up care. Lessons learned describe what is known and not known about factors that are related to or predict receipt of follow-up care. Similarly, effective interventions to increase follow-up are described and gaps identified. A conceptual model is developed that categorizes the health care system in the United States as comprising four levels: policy, practice, provider, and patient. Some patient-level factors that influence follow-up receipt are identified, but the lack of data severely limit the understanding of provider, practice, and policy-level correlates. The majority of intervention studies to increase follow-up receipt have focused on patient-level factors and have targeted follow-up of abnormal Papanicolaou smears. Insufficient information is available regarding the effectiveness of provider, practice, or policy-level interventions. Standard definitions of what constitutes appropriate follow-up are lacking, which severely limit comparability of findings across studies. The validity of various methods of obtaining outcome data has not been clearly established. More research is needed on interventions targeting provider, system, and policy-level factors, particularly interventions focusing on follow-up of colorectal and breast abnormalities. Standardization of definitions and measures is needed to facilitate comparisons across studies.
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Affiliation(s)
- Roshan Bastani
- Department of Health Services, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California 90095-6900, USA.
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Yabroff KR, Washington KS, Leader A, Neilson E, Mandelblatt J. Is the promise of cancer-screening programs being compromised? Quality of follow-up care after abnormal screening results. Med Care Res Rev 2003; 60:294-331. [PMID: 12971231 DOI: 10.1177/1077558703254698] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer screening has increased dramatically in the United States, yet in some populations, particularly racial minorities or the poor, advanced disease at diagnosis remains high. One potential explanation is that follow-up of abnormal tests is suboptimal, and the benefits of screening are not being realized. The authors used a conceptual model of access to care and integrated constructs from models of provider and patient health behaviors to review published literature on follow-up care. Most studies reported that fewer than 75 percent of patients received some follow-up care, indicating that the promise of screening may be compromised. They identified pervasive barriers to follow-up at the provider, patient, and health care system levels. Interventions that address these barriers appear to be effective. Improvement of data infrastructure and reporting will be important objectives for policy makers, and further use of conceptual models by researchers may improve intervention development and, ultimately, cancer control.
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Kerner JF, Yedidia M, Padgett D, Muth B, Washington KS, Tefft M, Yabroff KR, Makariou E, Freeman H, Mandelblatt JS. Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women. Prev Med 2003; 37:92-101. [PMID: 12855208 DOI: 10.1016/s0091-7435(03)00087-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Delayed or incomplete follow-up after abnormal screening results may compromise the effectiveness of breast cancer screening programs, particularly in medically underserved and minority populations. This study examined the role of socioeconomic status, breast cancer risk factors, health care system barriers, and patient cognitive-attitudinal factors in the timing of diagnostic resolution after abnormal breast cancer screening exams among Black women receiving breast cancer screening at three New York city clinics. METHODS We identified 184 Black women as having an abnormal mammogram or clinical breast exam requiring immediate follow-up and they were interviewed and their medical records examined. Bivariate and multivariate logistic regression analyses were used to assess the association between patient and health care system factors and diagnostic resolution within 3 months of the abnormal finding. RESULTS Within 3 months, 39% of women were without diagnostic resolution and 28% within 6 months. Neither socioeconomic status nor system barriers were associated with timely diagnostic resolution. Timely resolution was associated with mammogram severity, patients asking questions (OR, 2.73; 95% CI, 1.25-5.96), or receiving next step information (OR, 2.6; 95% CI, 1.08-6.21) at the initial mammogram. Women with prior breast abnormalities were less likely to complete timely diagnostic resolution (OR, 0.42; 95% CI, 0.20-0.85), as were women with higher levels of cancer anxiety (OR, 0.50; 95% CI, 0.27-0.92). CONCLUSIONS Interventions that address a woman's prior experience with abnormal findings and improve patient/provider communication may improve timely and appropriate follow-up.
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Affiliation(s)
- Jon F Kerner
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, MD 20892-0001, USA.
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Bastani R, Berman BA, Belin TR, Crane LA, Marcus AC, Nasseri K, Herman-Shipley N, Bernstein S, Henneman CE. Increasing cervical cancer screening among underserved women in a large urban county health system: can it be done? What does it take? Med Care 2002; 40:891-907. [PMID: 12395023 DOI: 10.1097/00005650-200210000-00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Further reduction in avoidable cervical cancer morbidity and mortality may require system-wide, integrated approaches implemented in the public health facilities serving the nation's indigent and minority women. OBJECTIVES Report on the evaluation of a 5-year demonstration project testing a multicomponent (provider, system, and patient) intervention to increase cervical cancer screening among women who receive their health care through the Los Angeles County Department of Health Services, the second largest County Health Department in the nation. MATERIALS AND METHODS A longitudinal nonequivalent control group design was utilized. Data were collected during a baseline (no intervention) year and 2.5 years of intervention. A large hospital, one feeder Comprehensive Health Centers (CHC), and three of the health center's feeder Public Health Centers (PHC) received the intervention. Another hospital, CHC and its three feeder PHCs (matched on size, patient characteristics, and range of services provided) served as comparison sites. Independent random samples of patients 18 years and older were drawn annually at each site (n = 18,642). The outcome measure was a receipt of a Papanicolaou smear during a 9-month period. RESULTS At the Hospital and CHC levels a statistically significant intervention effect was observed after controlling for baseline screening rates and case mix. No intervention effect was observed at the PHCs. CONCLUSION An intensive multicomponent intervention can increase cervical cancer screening in a large, urban, County health system serving a low-income minority population of under screened women. Retention of program elements in the postresearch phase, and the difficulties and importance of conducting this type of research, is described.
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Affiliation(s)
- Roshan Bastani
- From the School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, USA.
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