Social service barriers delay care among women with abnormal cancer screening.
Social service barriers delay care among women with abnormal cancer screening.
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社会服务障碍延迟了癌症筛查异常的女性的护理。
DOI：
10.1007/s11606-013-2615-x
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发表时间：
2014
影响因子：
5.7
通讯作者：
Battaglia,TracyA
中科院分区：
文献类型：
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作者：
Primeau,SarahW;Freund,KarenM;Ramachandran,Ambili;Bak,SharonM;Heeren,Timothy;Chen,ClaraA;Morton,Samantha;Battaglia,TracyA
少数群体和弱势群体癌症结果的不公平性与获得护理的障碍引起的癌症护理延误有关。社会服务障碍是指那些与满足生活最基本需求有关的障碍，如住房和收入，这些需求往往得到公共政策的支持，监管和服务。明确检查社会服务障碍与癌症筛查异常后及时诊断解决方案之间的关联。波士顿患者导航研究计划干预臂的二次分析（2007-2008年）在6个城市社区卫生服务中心进行。受试者与无障碍，其他障碍，和社会服务障碍进行了比较，他们的时间诊断resolution.SUBJECTSWomen ≥ 18岁的乳腺癌或宫颈癌筛查abnormality. MAINMEASURSSocial服务障碍包括：收入支持，住房和公用事业，教育和就业，和个人/家庭的稳定和安全。事件发生时间分析比较了五个组：没有障碍的人，一个障碍（其他），一个障碍（社会服务），两个或两个以上的障碍（所有其他），两个或两个以上的障碍（至少一个社会服务）。关键词1,481导航妇女; 31%西班牙裔，27%黑人，32%白色; 37%非英语发言者和28%有私人健康保险。88名妇女（6%）有社会服务障碍。与那些没有社会服务障碍的人相比，那些有社会服务障碍的人更有可能是西班牙裔，更年轻，有公共/没有健康保险，并且有多种障碍。那些有两个或两个以上的障碍（至少一个社会服务障碍），有最长的时间来解决相比，其他四组（aHR决议< 60天= 0.27，≥ 60天= 0.37）。如果社会服务障碍持续存在而没有被识别或解决，患者导航的影响可能永远不会完全实现。
BACKGROUNDInequity in cancer outcomes for minorities and vulnerable populations has been linked to delays in cancer care that arise from barriers to accessing care. Social service barriers represent those obstacles related to meeting life’s most basic needs, like housing and income, which are often supported by public policy, regulation and services.OBJECTIVETo examine the association between social service barriers and timely diagnostic resolution after a cancer screening abnormality.DESIGNSecondary analysis of the intervention arm of Boston Patient Navigation Research Program (2007–2008) conducted across six urban community health centers. Subjects with no barriers, other barriers, and social service barriers were compared on their time to diagnostic resolution.SUBJECTSWomen ≥ 18 years of age with a breast or cervical cancer screening abnormality.MAIN MEASURESSocial service barriers included: income supports, housing and utilities, education and employment, and personal/family stability and safety. Time to event analyses compared across five groups: those with no barriers, one barrier (other), one barrier (social service), two or more barriers (all other), and two or more barriers (at least one social service).KEY RESULTS1,481 navigated women; 31 % Hispanic, 27 % Black, 32 % White; 37 % non-English speakers and 28 % had private health insurance. Eighty-eight women (6 %) had social service barriers. Compared to those without social service barriers, those with were more likely to be Hispanic, younger, have public/no health insurance, and have multiple barriers. Those with two or more barriers (at least one social service barrier), had the longest time to resolution compared to the other four groups (aHR resolution < 60 days = 0.27, ≥ 60 days = 0.37).CONCLUSIONVulnerable women with multiple barriers, when at least one is a social service barrier, have delays in care despite navigation. The impact of patient navigation may never be fully realized if social service barriers persist without being identified or addressed.