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Adherence of low-income women to cancer screening recommendations

The roles of primary care, health insurance, and HMOs

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Abstract

BACKGROUND: African-American and low-income women have lower rates of cancer screening and higher rates of late-stage disease than do their counterparts.

OBJECTIVE: To examine the effects of primary care, health insurance, and HMO participation on adherence to regular breast, cervical, and colorectal cancer screening.

DESIGN: Random-digit-dial and targeted household telephone survey of a population-based sample.

SETTING: Washington, D.C. census tracts with ≥30% of households below 200% of federal poverty threshold.

PARTICIPANTS: Included in the survey were 1,205 women over age 40, 82% of whom were African American.

MAIN OUTCOME MEASURES: Adherence was defined as reported receipt of the last 2 screening tests within recommended intervals for age.

RESULTS: The survey completion rate was 85%. Overall, 75% of respondents were adherent to regular Pap smears, 66% to clinical breast exams, 65% to mammography, and 29% to fecal occult blood test recommendations. Continuity with a single primary care practitioner, comprehensive service delivery, and higher patient satisfaction with the relationships with primary care practitioners were associated with higher adherence across the 4 screening tests, after considering other factors. Coordination of care also was associated with screening adherence for women age 65 and over, but not for the younger women. Compared with counterparts in non-HMO plans, women enrolled in health maintenance organizations were also more likely to be adherent to regular screening (e.g., Pap, odds ratio [OR] 1.89, 95% confidence interval [CI] 1.11 to 3.17; clinical breast exam, OR 2.04, 95% CI 1.21 to 3.44; mammogram, OR 1.95, 95% CI 1.15 to 3.31; fecal occult blood test, OR 1.70, 95% CI 1.01 to 2.83.)

CONCLUSIONS: Organizing healthcare services to promote continuity with a specific primary care clinician, a comprehensive array of services available at the primary care delivery site, coordination among providers, and better patient-practitioner relationships are likely to improve inner-city, low-income women’s adherence to cancer screening recommendations.

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Authors and Affiliations

  1. the Departments of Oncology and Internal Medicine, Georgetown University Medical Center, Washington D.C.

    Ann S. O’Malley MD, MPH & Jeanne Mandelblatt MD, MPH

  2. the Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.

    Christopher B. Forrest MD, PhD

Authors
  1. Ann S. O’Malley MD, MPH
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  2. Christopher B. Forrest MD, PhD
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  3. Jeanne Mandelblatt MD, MPH
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Correspondence to Ann S. O’Malley MD, MPH.

Additional information

This work was funded in part by grant no. 17-97-1-7131 from the U.S. Department of the Army (ASO) and by grants RO3 CA83338-02 (ASO) and RO1 CA72908 (JM) from the National Cancer Institute.

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O’Malley, A.S., Forrest, C.B. & Mandelblatt, J. Adherence of low-income women to cancer screening recommendations. J GEN INTERN MED 17, 144–154 (2002). https://doi.org/10.1046/j.1525-1497.2002.10431.x

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