Author:
Castaldi Maria,Smiley Abbas,Kechejian Katharine,Butler Jonathan,Latifi Rifat
Abstract
Abstract
Background
Barriers to breast cancer screening remain despite Medicaid expansion for preventive screening tests and implementation of patient navigation programs under the Affordable Care Act. Women from underserved communities experience disproportionately low rates of screening mammography. This study compares barriers to breast cancer screening among women at an inner-city safety-net center (City) and those at a suburban county medical center (County). Inner city and suburban county medical centers’ initiatives were studied to compare outcomes of breast cancer screening and factors that influence access to care.
Methods
Women 40 years of age or older delinquent in breast cancer screening were offered patient navigation services between October 2014 and September 2019. Four different screening time-to-event intervals were investigated: time from patient navigation acceptance to screening mammography, to diagnostic mammography, to biopsy, and overall screening completion time. Barriers to complete breast cancer screening between the two centers were compared.
Results
Women from lowest income quartiles took significantly longer to complete breast cancer screening when compared to women from higher income quartiles when a barrier was present, regardless of barrier type and center. Transportation was a major barrier to screening mammography completion, while fear was the major barrier to abnormal screening work up.
Conclusion
Disparity in breast cancer screening and management persists despite implementation of a patient navigation program. In the presence of a barrier, women from the lowest income quartiles have prolonged breast cancer screening completion time regardless of center or barrier type. Women who experience fear have longest screening time completion. Future directions aim to increase resource allocation to ameliorate wait times in overburdened safety-net hospitals as well as advanced training for patient navigators to alleviate women’s fears.
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology,Reproductive Medicine,General Medicine
Reference30 articles.
1. Affordable Care Act State-Specific Medicaid Expansion: Impact on Health Insurance Coverage and Breast Cancer Screening Rate- Clinical Key. Accessed June 29, 2020. https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1072751520302131?returnurl=null&referrer=null
2. Castaldi M, Smiley A, Butler J, Latifi R. Breast cancer screening in inner city and county populations: a tale of two centers. Am Surg. 2020;87:982–7.
3. Get Screened, No Excuses. Welcome to the State of New York. Published December 31, 2015. https://www.ny.gov/GetScreened. Accessed 16 Aug 2020.
4. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. https://doi.org/10.1186/1475-9276-12-18.
5. Castaldi M, Safadjou S, Elrafei T, McNelis J. A multidisciplinary patient navigation program improves compliance with adjuvant breast cancer therapy in a public hospital. Am J Med Qual. 2017;32(4):406–13. https://doi.org/10.1177/1062860616656250.
Cited by
17 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献