Addressing Social Determinants of Health to Improve Access to Early Breast Cancer Detection: Results of the Boston REACH 2010 Breast and Cervical Cancer Coalition Women's Health Demonstration Project
Addressing Social Determinants of Health to Improve Access to Early Breast Cancer Detection: Results of the Boston REACH 2010 Breast and Cervical Cancer Coalition Women's Health Demonstration Project
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DOI：
10.1089/jwh.2008.0972
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发表时间：
2009-05-01
影响因子：
3.5
通讯作者：
Bigby, JudyAnn
中科院分区：
文献类型：
--
作者：
Clark, Cheryl R.;Baril, Nashira;Bigby, JudyAnn
背景资料：2010年波士顿社区健康种族和族裔方法（REACH）乳腺癌和宫颈癌联盟为非洲裔妇女制定了一项病例管理干预措施，以确定和减少乳腺癌筛查和跟踪异常结果的医疗和社会障碍。我们的目标是黑人妇女在高风险的癌症筛查不足，并遵循-由错过诊所预约和频繁使用紧急护理的先前模式证明。病例管理人员提供转介，以解决患者确定的社会问题（e。例如，在一个实施例中，交通、住房、语言障碍），以及导航，以及时筛查和跟踪异常检测。我们招募了437名40-75岁的黑人妇女，她们在参与的初级保健场所接受护理。该研究是一项前瞻性队列研究，而不是作为一个对照试验，并通过Logistic回归和及时随访异常测试通过考克斯比例风险models.Results：一个显着增加筛查摄取乳腺X线摄影摄取和纵向筛查率的干预效果进行评估（OR 1.53，95%CI 1.13-2.08）。住房问题（p< 0.05）和缺乏定期提供者（p< 0.01）预测乳腺X线摄影摄取率低。参与干预多年使获得推荐筛查的几率增加了20%（OR 1.20，95% CI 1.02-1.40），但协变量减弱了这种影响（p = 0.53）。及时跟进的异常结果，实现了大多数妇女（85%），但不能归因于干预（HR 0.95，95% CI 0.50-1.80）。结论：病例管理是成功的，在促进乳腺X线摄影筛查摄取，虽然没有改变纵向patterns被发现。住房问题和缺乏定期提供者应予以解决，以促进乳腺X线摄影摄取。未来的研究应提供社会评估，并在随机对照设置中解决社会障碍，以确认社会决定因素方法的有效性，以提高乳腺X线摄影的使用。
Background: The Boston Racial and Ethnic Approaches to Community Health (REACH) 2010 Breast and Cervical Cancer Coalition developed a case management intervention for women of African descent to identify and reduce medical and social obstacles to breast cancer screening and following up abnormal results.Methods: We targeted black women at high risk for inadequate cancer screening and follow-up as evidenced by a prior pattern of missed clinic appointments and frequent urgent care use. Case managers provided referrals to address patient-identified social concerns (e. g., transportation, housing, language barriers), as well as navigation to prompt screening and follow-up of abnormal tests. We recruited 437 black women aged 40-75, who received care at participating primary care sites. The study was conducted as a prospective cohort study rather than as a controlled trial and evaluated intervention effects on mammography uptake and longitudinal screening rates via logistic regression and timely follow-up of abnormal tests via Cox proportional hazards models.Results: A significant increase in screening uptake was found (OR 1.53, 95% CI 1.13-2.08). Housing concerns (p< 0.05) and lacking a regular provider (p< 0.01) predicted poor mammography uptake. Years of participation in the intervention increased odds of obtaining recommended screening by 20% (OR 1.20, 95% CI 1.02-1.40), but this effect was attenuated by covariates (p = 0.53). Timely follow-up for abnormal results was achieved by most women (85%) but could not be attributed to the intervention (HR 0.95, 95% CI 0.50-1.80).Conclusions: Case management was successful at promoting mammography screening uptake, although no change in longitudinal patterns was found. Housing concerns and lacking a regular provider should be addressed to promote mammography uptake. Future research should provide social assessment and address social obstacles in a randomized controlled setting to confirm the efficacy of social determinant approaches to improve mammography use.