Small-area variation in screening for cancer, glucose and cholesterol in Ontario: a cross-sectional study

Abstract

Background: Screening for cervical, breast and colon cancers, and elevations of cholesterol and glucose, reduces pre mature causespecific mortality from these cancers and circulatory diseases. Despite primary care reforms and incentives, and promotion of cancer-screening programs among individuals, participation is suboptimal. We aimed to examine participation as of Dec. 31, 2011, by factors of deprivation, demographics and primary care at the small-area level. Methods:From health care administrative databases, we identified people eligible for each screening test, and their participation, in each dissemination area (referred to as small areas, n = 18 950) in Ontario. We calculated rates for each test among small areas (overall and stratified by demographic, socioeconomic and primary care descriptors) and stratified by sex for all tests combined. We loaded all data into a geographic information system. Funnel plots were generated showing the percentage of eligible people who completed screening for all tests by small area, stratified by sex. Overall and stratified screening prevalence ratios were calculated among small areas.Results: Among small areas, the mean and SD for participation in all tests combined was 31.6% (SD 11.0%) for women and 41.2% (SD 12.0%) for men. Screening prevalence among small areas, for each test and for all tests combined, overall and stratified by sex, declined with decreasing percentage with high school completion, decreasing socioeconomic quintile, and decreasing percentage with an identifiable primary care physician. Interpretation:Our results show that the rate of participation in all eligible screening tests among small areas is much lower than the rate of participation in any one particular test. This finding has implications for the design and implementation of strategies to improve rates of screening. Abstract Research CMAJ OPEN E374CMAJ OPEN, 3(4) Study designThis is a crosssectional study of smallarea variation in screening participation in Ontario.

Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada

“…Our finding that RA patients had less cancer screening than their non‐RA counterparts is consistent with previous work indicating that chronic diseases may act as barriers to certain medical services , possibly due to the time dedicated to managing the chronic disease itself. While there are conflicting reports on whether or not RA patients receive fewer cancer screening tests than non‐RA patients within the US , cancer screening in Ontario is not optimal in general , despite financial incentives for primary care physicians to screen for cancer . Conversely, influenza and pneumococcal vaccinations and bone mineral density testing were more frequent among RA patients, likely due to corticosteroid/immunosuppressant use, or perhaps due to more frequent contact with multiple care providers to recommend them.…”

“…Patients with prior cancers were excluded from these quality measures, using the Ontario Cancer Registry for cancer ascertainment. Additionally, certain procedures (e.g., mammograms or colonoscopies) occur outside primary care offices, and these diagnostic reports are not comprehensively captured in a consistent manner in EMRs, which necessitated incorporating procedure codes from administrative data, for which methods for identifying cancer screenings have been previously developed and assessed .…”

Cervical Cancer Screening among Women from Muslim-Majority Countries in Ontario, Canada

“…Disparities in cervical cancer screening are well documented in Canada, with foreign-born women being persistently less likely to be up to date on Pap testing (1)(2)(3)(4)(5). In particular, women from South Asia, the Middle East, and North Africa have a lower likelihood of appropriate cervical cancer screening than Canadian-born women and than immigrant women from other parts of the world (3,4).…”

BETTER HEALTH: Durham -- protocol for a cluster randomized trial of BETTER in community and public health settings

“…Our previous work identified census dissemination areas in Ontario (Canada) within the lowest quintile of median household income. Persons living in these areas seem to face a variety of barriers accessing primary care service as they have low cancer screening rates, are least likely to have a regular primary care provider, and have the lowest average number of primary care visits [ 1 ]. In Ontario, primary care providers (PCPs) typically provide screening for cervical, colorectal, and breast cancer, and assessment and screening for cardiovascular and diabetes risk factors.…”

“…In Ontario, primary care providers (PCPs) typically provide screening for cervical, colorectal, and breast cancer, and assessment and screening for cardiovascular and diabetes risk factors. Despite increased funding for Patient Enrollment Models of primary care, and financial incentives to PCPs for cancer screening, access to primary care and participation in cancer screening in Ontario have not improved, particularly not in low imcome areas [ 1 – 3 ]. Two notable strategies have been previously implemented: 1) community health centres, targetting those with multiple morbidities in low income areas, and 2) incentive payments to primary care providers for cancer screening participation by their patients.…”