The Prostate Outreach Project (POP) provided free prostate cancer (PCa) education and early detection to medically underserved communities. POP recruited subjects in medically underserved communities. PCa education and detection events occurred in POP locations (static) or natural gathering places (mobile) within the community. PCa education was delivered by video and evaluated using a questionnaire. Screening consisted of serum prostate specific antigen (PSA) and digital rectal examination (DRE). A navigated follow-up strategy was utilized to provide medical care for subjects with abnormal screening examinations (ASE). POP recruited 4420 men, 62.8% (2667) were African American (AA). Most participants had a high school education, and no prior screening. Fifty four percent (2159) were uninsured and 41% (1811) had no access to a physician. PCa knowledge increased following the educational video. PSA levels were elevated in 9.8% (436) while 233(6.9%) had an abnormal DRE. Follow-up among 609 men with ASE was successful in 40% (244), despite a navigated approach. Overall 3.3% (144) cancers were diagnosed among the POP with AA subjects exhibiting a significantly higher incidence. Recruitment, education, and PCa testing among a medically underserved cohort was successful. However failure to follow through on ASE could contribute to maintaining the disparity in PCa outcomes noted among AAs and the medically underserved if not addressed.
INTRODUCTION AND OBJECTIVES: Compliance with 24hour urine collections for assessing stone risk is important for assigning appropriate preventive therapy. The objectives of this study were to determine factors associated with compliance and the impact of an intervention introduced to improve this outcome.METHODS: In 2015, the patients in our stone clinic in whom 24 hour urine testing was desired were instructed to contact the vendor (Litholink) and given an instructional sheet provided by this company to arrange for the collections. In 2016, a practice change was implemented and clinic staff sent all urine study requests to the vendor by FAX. During this 2-year period, 24-hour urine studies were ordered by the treating physician in 368 adult stoneformers (SF). Demographic data analyzed included age, gender, race, insurance status, partner status, income, and education. Statistical analysis methods included ANOVA, Fisher's exact test, Chi-squared, and t-test analyses. Compliance was determined based on completion of 24-hour urine collections. Data were analyzed for 2015, 2016, and both years combined (2015/2016).RESULTS: Average age of SF was 49.6 years at time of collection. 47.5% of SF were female. The majority were Caucasians (84.2%) and 15.8% were African Americans. Most patients were adequately insured (90.5%) and the majority had domestic partners (61.4%). Compliance increased after the intervention from 46.9% to 65.1% (p<0.001). Adequate insurance was associated with increased compliance for both years combined (58.3% vs 37.15%, p¼0.017). Partner status and older age were associated with increased compliance in 2015 (54.2% vs 32.8% p¼0.006; 52.9 years vs 47.1 years p¼0.014), but following intervention in 2016 were no longer contributing factors.CONCLUSIONS: A simple intervention increased compliance with performance of 24 hour urine testing by 18% and eliminated health disparities (age, partner status). Inadequate insurance status resulted in poor compliance despite this intervention.
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