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Thompson JH, Rivelli JS, Schneider JL, Kenzie ES, Myers E, Coury J, Davis M, Gautom P, Coronado GD. Adaptations to a patient navigation program for follow-up colonoscopy in rural primary care practices. J Eval Clin Pract 2024; 30:1457-1466. [PMID: 38935862 DOI: 10.1111/jep.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/09/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Patient navigation is a recommended practice to improve cancer screenings among underserved populations including those residing in rural areas with care access barriers. We report on patient navigation programme adaptations to increase follow-up colonoscopy rates after abnormal fecal testing in rural primary care practices. METHODS Participating clinics delivered a patient navigation programme to eligible patients from 28 affiliated clinics serving rural communities in Oregon clustered within 3 Medicaid health plans. Patient navigation adaptations were tracked using data sources including patient navigation training programme reflections, qualitative interviews, clinic meetings, and periodic reflections with practice facilitators. FINDINGS Initial, planned (proactive) adaptations were made to address the rural context; later, unplanned (reactive) adaptations were implemented to address the impact of the COVID-19 global pandemic. Initial planned adaptations to the patient navigation programme were made before the main trial to address the needs of the rural context, including provider shortages and geographic dispersion limiting both patient access to care and training opportunities for providers. Later unplanned adaptations were made primarily in response to COVID-19 care suspension and staff redeployments and shortages that occurred during implementation. CONCLUSION While unplanned adaptations were implemented to address the contextual impact of the COVID-19 pandemic on care access patterns and staffing, the changes to training content and context were beneficial to the rural setting overall and should be sustained. Our findings can guide future efforts to optimise the success of such programmes in other rural settings and highlight the important role of adaptations in implementation projects.
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Affiliation(s)
- Jamie H Thompson
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Jennifer S Rivelli
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Jennifer L Schneider
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Erin S Kenzie
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
- OHSU-PSU School of Public Health Division, Oregon Health & Science University, Portland, Oregon, USA
| | - Emily Myers
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer Coury
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
| | - Melinda Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA
- OHSU-PSU School of Public Health Division, Oregon Health & Science University, Portland, Oregon, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Priyanka Gautom
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
- OHSU-PSU School of Public Health Division, Oregon Health & Science University, Portland, Oregon, USA
| | - Gloria D Coronado
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
- Department of Population Sciences, University of Arizona Cancer Center, Tucson, Arizona, USA
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Ahadinezhad B, Maleki A, Akhondi A, Kazemi M, Yousefy S, Rezaei F, Khosravizadeh O. Are behavioral economics interventions effective in increasing colorectal cancer screening uptake: A systematic review of evidence and meta-analysis? PLoS One 2024; 19:e0290424. [PMID: 38315699 PMCID: PMC10843112 DOI: 10.1371/journal.pone.0290424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/08/2023] [Indexed: 02/07/2024] Open
Abstract
Various interventions have been investigated to improve the uptake of colorectal cancer screening. In this paper, the authors have attempted to provide a pooled estimate of the effect size of the BE interventions running a systematic review based meta-analysis. In this study, all the published literatures between 2000 and 2022 have been reviewed. Searches were performed in PubMed, Scopus and Cochrane databases. The main outcome was the demanding the one of the colorectal cancer screening tests. The quality assessment was done by two people so that each person evaluated the studies separately and independently based on the individual participant data the modified Jadad scale. Pooled effect size (odds ratio) was estimated using random effects model at 95% confidence interval. Galbraith, Forrest and Funnel plots were used in data analysis. Publication bias was also investigated through Egger's test. All the analysis was done in STATA 15. From the initial 1966 records, 38 were included in the final analysis in which 72612 cases and 71493 controls have been studied. About 72% have been conducted in the USA. The heterogeneity of the studies was high based on the variation in OR (I2 = 94.6%, heterogeneity X2 = 670.01 (d.f. = 36), p < 0.01). The random effect pooled odds ratio (POR) of behavioral economics (BE) interventions was calculated as 1.26 (95% CI: 1.26 to 1.43). The bias coefficient is noteworthy (3.15) and statistically significant (p< 0.01). According to the results of this meta-analysis, health policy and decision makers can improve the efficiency and cost effectiveness of policies to control this type of cancer by using various behavioral economics interventions. It's noteworthy that due to the impossibility of categorizing behavioral economics interventions; we could not perform by group analysis.
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Affiliation(s)
- Bahman Ahadinezhad
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Aisa Maleki
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Amirali Akhondi
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Sama Yousefy
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Rezaei
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Omid Khosravizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Coronado GD, Anyane-Yeboa A, Byhoff E, Escaron AL, Sonik R, Talamantes E, Neslund-Dudas C. Greater Investments in Safety Net Health Systems Can Help Diversify Participation in Clinical Trials and Research. J Gen Intern Med 2024; 39:312-315. [PMID: 37884838 PMCID: PMC10853098 DOI: 10.1007/s11606-023-08489-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Affiliation(s)
| | - Adjoa Anyane-Yeboa
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Byhoff
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Anne L Escaron
- AltaMed Institute for Health Equity, AltaMed Health Services Corporation, Los Angeles, CA, USA
| | - Rajan Sonik
- AltaMed Institute for Health Equity, AltaMed Health Services Corporation, Los Angeles, CA, USA
- Institute on Healthcare Systems, the Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Efrain Talamantes
- AltaMed Institute for Health Equity, AltaMed Health Services Corporation, Los Angeles, CA, USA
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