Improving mammography screening among the medically underserved

Terry C. Davis, Alfred Rademaker, Charles L. Bennett, Michael S. Wolf, Edson Carias, Cristalyn Reynolds, Dachao Liu, Connie L. Arnold

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings. METHODS: A three-arm, quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana. Mammography screening efforts included: 1) enhanced care, 2) health literacy-informed education of patients, and 3) education plus nurse support. Outcomes included mammography screening completion within 6 months and incremental cost-effectiveness. RESULTS: Overall, 1,181 female patients ages 40 and over who were eligible for routine mammography were recruited. Baseline screening rates were < 10 %. Post intervention screening rates were 55.7 % with enhanced care, 51.8 % with health literacy-informed education and 65.8 % with education and nurse support. After adjusting for race, marital status, self-efficacy and literacy, patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care; those additionally receiving nurse support were 1.37-fold more likely to complete mammographic screening than those receiving the brief education (95 % Confidence Interval 1.08-1.74, p=0.01). The incremental cost per additional women screened was $2,457 for literacy-informed education with nurse support over literacy-informed education alone. CONCLUSIONS: Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative, with nurse support and follow-up being the most effective option. However, it is not likely to be cost-effective or affordable in resource-limited clinics.

Original languageEnglish (US)
Pages (from-to)628-635
Number of pages8
JournalJournal of general internal medicine
Volume29
Issue number4
DOIs
StatePublished - Apr 2014
Externally publishedYes

Fingerprint

Mammography
Education
Health Literacy
Nurses
Cost-Benefit Analysis
Costs and Cost Analysis
Marital Status
Self Efficacy
Patient Education
Confidence Intervals
Safety
Health
Literacy

Keywords

  • cancer screening
  • community clinics
  • health literacy
  • mammography
  • underserved populations

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Davis, T. C., Rademaker, A., Bennett, C. L., Wolf, M. S., Carias, E., Reynolds, C., ... Arnold, C. L. (2014). Improving mammography screening among the medically underserved. Journal of general internal medicine, 29(4), 628-635. https://doi.org/10.1007/s11606-013-2743-3

Improving mammography screening among the medically underserved. / Davis, Terry C.; Rademaker, Alfred; Bennett, Charles L.; Wolf, Michael S.; Carias, Edson; Reynolds, Cristalyn; Liu, Dachao; Arnold, Connie L.

In: Journal of general internal medicine, Vol. 29, No. 4, 04.2014, p. 628-635.

Research output: Contribution to journalArticle

Davis, TC, Rademaker, A, Bennett, CL, Wolf, MS, Carias, E, Reynolds, C, Liu, D & Arnold, CL 2014, 'Improving mammography screening among the medically underserved', Journal of general internal medicine, vol. 29, no. 4, pp. 628-635. https://doi.org/10.1007/s11606-013-2743-3
Davis, Terry C. ; Rademaker, Alfred ; Bennett, Charles L. ; Wolf, Michael S. ; Carias, Edson ; Reynolds, Cristalyn ; Liu, Dachao ; Arnold, Connie L. / Improving mammography screening among the medically underserved. In: Journal of general internal medicine. 2014 ; Vol. 29, No. 4. pp. 628-635.
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