National Institutes of Health Pathways to Prevention Workshop: Achieving Health Equity in Preventive Services

Carey, Timothy S.; Bekemeier, Betty; Campos‐Outcalt, Doug; Koch‐Weser, Susan; Millon‐Underwood, Sandra; Teutsch, Steven M.

doi:10.7326/m19-3171

Cited by 14 publications

(13 citation statements)

References 7 publications

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“…Limitations of this review include using only Englishlanguage articles and studies applicable to the USA, although this focus improves its relevance to the Pathways to Prevention Workshop on Achieving Health Equity in Preventive Services. 58,59 This review demonstrated small study effects for colorectal cancer screening, which may be due to publication bias. Screening rates remained higher with patient navigation when only large clinical trials were included in the meta-analysis suggesting that interventions were effective regardless of study size, although large studies could overestimate the effect size.…”

Section: Discussionmentioning

confidence: 90%

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis

et al. 2020

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BACKGROUND: This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities. METHODS: Eligible studies were identified through English-language searches of Ovid® MEDLINE®, Psy-cINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019 and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models. RESULTS: Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I 2 = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I 2 = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I 2 = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I 2 = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality. CONCLUSIONS: In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services.

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Section: Discussionmentioning

confidence: 90%

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis

et al. 2020

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“…The resulting tool improved the decision-making process around T2DM prevention among diverse primary care patients, including Spanish speakers and those with limited educational attainment. Such decision tools that are effective for underserved groups may promote health equity in diabetes prevention, 52,53 which should be the focus of future research. In contrast to prior studies, the current analysis examined patient-reported outcomes that underlie subsequent treatment choices and behavioral changes, providing further empiric evidence to support this tool’s use.…”

Section: Discussionmentioning

confidence: 99%

Development and Evaluation of a Prediabetes Decision Aid in Primary Care: Examining Patient-Reported Outcomes by Language Preference and Educational Attainment

Bandi

Vargas

Lopez

et al. 2021

The Science of Diabetes Self-Management and Care

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Purpose The purpose of this study was to examine the development and preliminary effectiveness of a novel Prediabetes Decision Aid on adoption of intensive lifestyle interventions (ILIs) and metformin. Little research has focused on increasing uptake of these evidence-based treatments, especially among non-English speakers and those with low educational attainment. Methods Investigators developed an English and Spanish decision aid displaying information about type 2 diabetes (T2DM) risk and treatments to prevent T2DM and prompting patients to identify next steps for management. This pilot study was a single-arm, pretest-posttest trial of 40 adult patients with prediabetes, obesity, and ≥1 office visit within the prior 12 months. Participants reviewed this tool briefly with a study team member, and data were collected on 3 coprimary outcomes: knowledge about T2DM risk, decisional conflict, and intention to adopt treatment. Exploratory outcomes included subsequent documentation of prediabetes in chart notes and adoption of ILIs or metformin. Results Almost all participants were women, with nearly half expressing Spanish language preference and low educational attainment. A nonsignificant increase in knowledge was observed across all subgroups. Decisional conflict was significantly reduced from pretest to posttest and was similar between subgroups defined by language preference and educational attainment. While intention to adopt ILIs increased across all subgroups, this change was only significant among Spanish speakers and participants with low educational attainment. At 6 months, 17 participants had subsequent provider documentation of prediabetes, and 12 adopted ILIs or metformin. Conclusions The decision aid improved patient-reported outcomes and promoted treatment adoption in a diverse patient sample.

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“…A systematic review of 10 preventive services recommended by the US Preventive Services Task Force (USPSTF) found that patient navigation, telephone calls and prompts, and reminders involving lay health workers increase colorectal, breast, and cervical cancer screening rates [36]. One of the 26 recommendations made by the workshop panel suggests seeking cross-sector collaborations that incorporate the clinical care system, public health, and community-based organizations [6].…”

Section: Prevention and Disparitiesmentioning

confidence: 99%

“…Socioeconomic constraints, health care provider shortages, and a lack of health insurance contribute to higher mortality rates relative to their urban counterparts [5]. Although certain barriers can be addressed at federal or state levels, regional or community-level interventions including preventive practice and early disease detection and treatment may be more effective and efficient to improve rural health outcomes in a timely manner [6]. The Secretary of Health and Human Services (HHS) identified rural health as a Department priority and established the Rural Health Task Force in late 2018.…”

Section: Introductionmentioning

confidence: 99%

The CTSA program’s role in improving rural public health: Community-engaged disease prevention and health care innovation

Zhang

Kurilla

Austin

2020

J. Clin. Trans. Sci.

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National Institutes of Health Pathways to Prevention Workshop: Achieving Health Equity in Preventive Services

Cited by 14 publications

References 7 publications

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis

Development and Evaluation of a Prediabetes Decision Aid in Primary Care: Examining Patient-Reported Outcomes by Language Preference and Educational Attainment

The CTSA program’s role in improving rural public health: Community-engaged disease prevention and health care innovation

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