Randomized Controlled Trial of Mammography Intervention in Insured Very Low-Income Women
Randomized Controlled Trial of Mammography Intervention in Insured Very Low-Income Women
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DOI：
10.1158/1055-9965.epi-10-0141
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发表时间：
2010-07-01
影响因子：
3.8
通讯作者：
Hargreaves, Margaret K.
中科院分区：
文献类型：
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作者：
Ahmed, Nasar U.;Haber, Gillian;Hargreaves, Margaret K.
背景：保险覆盖范围缩小健康差距并平等医疗保健使用的期望假设服务是平等获得的；然而，本次研究中参保低收入目标人群的乳腺X线检查率为23.4%，远低于一般人群。我们的目标是确定最有效的干预措施，以改善受管理医疗组织 (MCO) 保险的低收入女性的乳房 X 光检查使用情况。方法：该研究是一项随机对照试验。参与者为 2,357 名不符合筛查乳房 X 光检查的女性，随机分配到三组之一：对照组 (n = 786) 接受常规护理；对照组 (n = 786) 接受常规护理；简单干预（n = 785）收到 MCO 医疗主任的提示信；逐步干预（n = 786）收到了来自MCO的相同提示信；如果不合规，则由初级保健医生发出第二封提示信；如果仍然不合规，则由非专业卫生工作者提供咨询。结果是完成从病历中提取的乳房 X 光检查筛查。结果：对照的筛查率为 13.4%，简单干预的筛查率为 16.1%，逐步干预的筛查率为 27.1%。与对照相比，逐步干预中的初级保健医生信使筛查的可能性增加了 80% [相对风险 (RR) = 1.80； P < 0.001]，并且咨询使筛查的可能性增加了两倍（RR = 3.11；P < 0.001）。结论：与对照和简单干预相比，增加乳房X光检查的逐步干预对于难以接触到的低收入参保女性目标人群是有效的。影响：该研究提供了证据证明逐步干预对改善低收入参保人群癌症筛查的影响，尽管筛查率仍然很高低于一般人群。癌症流行病学生物标志物19(7)； 1790-8。 (C) 2010 AACR。
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. (C) 2010 AACR.