Telephone care management to improve cancer screening among low-income women - A randomized, controlled trial
Telephone care management to improve cancer screening among low-income women - A randomized, controlled trial
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DOI：
10.7326/0003-4819-144-8-200604180-00006
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发表时间：
2006-04-18
影响因子：
39.2
通讯作者：
Younge, RG
中科院分区：
文献类型：
--
作者：
Dietrich, AJ;Tobin, JN;Younge, RG
背景：少数族裔和低收入妇女接受的癌症筛查比其他妇女更少。目的：评价电话支持干预措施对提高少数族裔和低收入妇女乳腺癌、宫颈癌和结直肠癌筛查率的效果。设计：2001年11月至2004年4月间进行的随机对照试验。地点：纽约市11个社区和移民健康中心。患者：1413名逾期接受癌症筛查的妇女。干预：在18个月的时间里，被分配到干预组的妇女平均接到4次来自预防护理经理的电话，而被分配到控制组的妇女接受常规护理。99%的女性获得了随访数据，91%的干预组至少接到了一次电话。测量：根据美国预防服务工作组的建议，乳房X光检查、巴氏检查和结直肠癌筛查的病历记录。结果：接受乳房X光检查的妇女比例从干预前的0.58增加到0.68，在常规护理下从0.60下降到0.58；接受巴氏检查的妇女比例从干预后的0.71增加到0.78，常规护理的没有变化；结直肠癌筛查的比例从干预后的0.39增加到0.63，从0.39增加到0.50。两组筛查率的差异：乳房X光摄影为0.12(95%CI，0.06至0.19)，巴氏检查(CI，0.01至0.12)为0.07，结直肠筛查(CI，0.07至0.19)为0.13。随着干预措施的实施，接受过3次测试的女性比例从0.21增加到0.43。限制：参与者来自1个城市，有机会获得定期护理。医疗记录可能没有涵盖所有的癌症筛查。结论：电话支持可以提高去社区和流动人口卫生中心就诊的女性的癌症筛查率。这种干预措施似乎非常适合寻求提高癌症筛查率和解决护理差距的医疗计划、大型医疗组织和其他组织。
Background: Minority and low-income women receive fewer cancer screenings than other women.Objective: To evaluate the effect of a telephone support intervention to increase rates of breast, cervical and colorectal cancer screening among minority and low-income women.Design: Randomized, controlled trial conducted between November 2001 and April 2004.Setting: 11 community and migrant health centers in New York city.Patients: 1413 women who were overdue for cancer screening. Intervention: Over 18 months, women assigned to the intervention group received an average of 4 calls from prevention care managers and women assigned to the control group received usual care. Follow-up data were available for 99% of women, and 91 % of the intervention group received at least 1 call. Measurements: Medical record documentation of mammography, Papanicolaou testing, and colorectal cancer screening according to U.S. Preventive Services Task Force recommendations.Results: The proportion of women who had mammography increased from 0.58 to 0.68 with the intervention and decreased from 0.60 to 0.58 with usual care; the proportion who had Papanicolaou testing increased from 0.71 to 0.78 with the intervention and was unchanged with usual care; and the proportion who had colorectal screening increased from 0.39 to 0.63 with the intervention and from 0.39 to 0.50 with usual care. The difference in the change in screening rates between groups was 0.12 for mammography (95% Cl, 0.06 to 0.19), 0.07 for Papanicolaou testing (Cl, 0.01 to 0.12), and 0.13 for colorectal screening (Cl, 0.07 to 0.19). The proportion of women who were up to date for 3 tests increased from 0.21 to 0.43 with the intervention.Limitations: Participants were from 1 city and had access to a regular source of care. Medical records may not have captured all cancer screenings.Conclusions: Telephone support can improve cancer screening rates among women who visit community and migrant health centers. The intervention seems to be well suited to health plans, large medical groups, and other organizations that seek to increase cancer screening rates and to address disparities in care.