Enhancing Mammography Use in the Inner City

Weber, Barbara E.; Reilly, Brendan M.

doi:10.1001/archinte.1997.00440410077008

Cited by 60 publications

(9 citation statements)

References 29 publications

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“…However, given these differences, the results of the stepwise multicomponent intervention were consistent with at least two other studies testing multistrategy approaches in low income women, albeit with lower rate increases. Compared with the 27% increase seen in our stepwise intervention group, Weber et al (37) found a 41% increase and Champion et al (38) found a 49% to 55% increase through the use of multicomponent interventions. Other studies have shown mixed results (39) or nonsignificant results (40).…”

Section: Discussioncontrasting

confidence: 68%

Randomized Controlled Trial of Mammography Intervention in Insured Very Low–Income Women

Ahmed

Haber

Semenya

et al. 2010

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: The expectation that insurance coverage mitigates health disparities and equalizes use of healthcare assumes that services are equally accessed; however, the insured low-income target population in this research had a mammography rate of 23.4%, well below the general population. Our objective was to determine the most effective intervention to improve mammography use in low-income women insured by a managed care organization (MCO).Methods: The study was a randomized controlled trial. Participants were 2,357 women noncompliant with screening mammography randomly assigned to one of three groups: control (n = 786) received usual care; simple intervention (n = 785) received prompt letter from the MCO medical director; and stepwise intervention (n = 786) received the same prompt letter from the MCO; if noncompliant, a second prompt letter from their primary care physician and, if still noncompliant, counseling from lay health workers. Outcome was completion of screening mammography extracted from medical records.Results: Screening rates were 13.4% for the control, 16.1% for the simple intervention, and 27.1% for the stepwise intervention. Compared with the control, the primary care physician letter in the stepwise intervention increased the likelihood of screening by 80% [Relative Risk (RR) = 1.80; P < 0.001], and counseling tripled the likelihood of screening (RR = 3.11; P < 0.001).Conclusions: Compared with the control and simple intervention, a stepwise intervention to increase mammography is effective in a target population of hard-to-reach, low-income, insured women.Impact: The research provides evidence for the impact of stepwise interventions to improve cancer screening in low-income insured populations, although the screening rates remain well below those of the general population. Cancer Epidemiol Biomarkers Prev; 19(7); 1790-8. ©2010 AACR.

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Section: Discussioncontrasting

confidence: 68%

Randomized Controlled Trial of Mammography Intervention in Insured Very Low–Income Women

Ahmed

Haber

Semenya

et al. 2010

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Native-American and Southeast-Asian women, who had the lowest screening rates, had 20% to 25% improvements. Similar interventions, some of which included referral to a nurse practitioner, have been successful in primary care and emergency department settings, 14,15,[17][18][19] but have not been tested previously in non-primary-care clinics. Approximately one quarter of our study participants could not identify a regular health care provider.…”

Section: Discussionmentioning

confidence: 99%

“…This approach has been successful in primary care settings, [14][15][16][17] and in a public hospital emergency department. 18 Some studies have used nurses to deliver screening recommendations; however, several studies involving minority populations have employed culturally sensitive lay health advisers in medical settings 19 and in the community. 14,20,21 These studies have demonstrated the ability of trained lay workers to counsel women who have not responded to or have not received screening recommendations from traditional health care providers.…”

mentioning

confidence: 99%

Increasing breast and cervical cancer screening in low-income women

et al. 1998

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OBJECTIVE:To determine if women would have higher breast and cervical cancer screening rates if lay health advisers recommended screening and offered a convenient screening opportunity. DESIGN: Controlled trial. SETTING: Urban county teaching hospital.PARTICIPANTS: Women aged 40 years and over attending appointments in several non-primary-care outpatient clinics. INTERVENTIONS:Lay health advisers assessed the participants' breast and cervical cancer screening status and offered women in the intervention group who were due for screening an appointment with a female nurse practitioner. MEASUREMENTS AND MAIN RESULTS:Screening rates at baseline and at follow-up 1 year after the intervention were determined. At follow-up, the mammography rate was 69% in the intervention group versus 63% in the usual care group ( p ‫؍‬ .009), and the Pap smear rate was 70% in the intervention group versus 63% in the usual care group ( p ‫؍‬ .02). In women who were due for screening at baseline, the mammography rate was 60% in the intervention group versus 50% in the usual care group ( p ‫؍‬ .006), and the Pap smear rate was 63% in the intervention group versus 50% in the usual care group ( p ‫؍‬ .002). The intervention was effective across age and insurance payer strata, and was particularly effective in Native American women. CONCLUSIONS:Breast and cervical cancer screening rates were improved in women attending non-primary-care outpatient clinics by using lay health advisers and a nurse practitioner to perform screening. The effect was strongest in women in greatest need of screening.KEY WORDS: mass screening; vaginal smears; mammography; nurse practitioners; community health aides. J GEN INTERN MED 1998;13:515-521.S creening mammography and Pap smears have been shown convincingly to decrease breast and cervical cancer mortality. 1,2 Recent population-based surveys suggest progress toward the year 2000 goals in the general population for both breast and cervical cancer screening. 3,4 However, nonwhite women, older women, and those with lower incomes and less education generally have lower screening rates. [4][5][6] Strategies to improve screening rates in these groups are needed.Hennepin County Medical Center, the urban county teaching hospital in Minneapolis, serves many women from groups that are less likely to receive breast and cervical cancer screening. Preliminary reviews of the charts of women attending appointments in the general medicine clinic, medical subspecialty clinics, and surgical clinics, showed the lowest screening rates in women attending surgical clinics (K.L. Margolis, unpublished data). Primary care physicians have been urged to "put prevention into practice" with each patient contact, 7 but few specialists are prepared to utilize each patient contact this way. Physicianoriented interventions such as education, 8 feedback of screening rates, 9 checklists, 10,11 nurse-generated reminders, 12 and computer-generated reminders 9,13 have been modestly successful in increasing cancer screening in primary care setting...

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“…For example, a nurse-initiated prompting system, flow sheets, and computerized reminders have all been shown to increase the delivery of preventive services [33][34][35][36] and may be well advised here. Among urban minorities, compliance with preventive measures has been enhanced by an intense, personal intervention designed to remove barriers to care, 37 and by computerized patient reminders. 38 Other interventions such as mobile units, videotapes, culturally relevant educational material, 39 or site of service modification 34 also may be useful in caring for AI/AN populations.…”

Section: Discussionmentioning

confidence: 99%