Medical Inspection – Health Blog

This study identified high rates of self-reported breast and cervical cancer screening among poor, African-American, Puerto Rican women and non-Hispanic white women living in the inner-city with access to primary care. This shows that primary care truly can have a positive impact on the receipt of preventive health services among minority, low-income women. The screening rates found in this study were compared to national averages. Receipt of a Pap smear in the past three years according to self-report (96%) and chart review (92%) exceeds the Healthy People 2010 goal of 90%. Self report of mammography in this study (91%) exceeds the Health People 2010 goal of 70% of women over 40 receiving a mammogram within the preceding two years. However, chart documentation of mammography (57%) is below the 2010 goal. This study used 1997 American Cancer Society Guidelines to assess appropriateness of screening. We did not assess the guidelines that the patients’ physicians inherently followed if any. Self-report of receipt of mammography and Pap smear was consistently higher than medical record documentation of screening. Self-report misrepresented actual screening practices as identified by high sensitivity rates and low specificity rates. However, high negative predictive values suggested that asking women about their recent mammography use may be an inexpensive, easy intervention to increase screening among women currently not being screened by encouraging dialog between patient and provider about reasons for not being screened and/or other means of obtaining screens.

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All demographic data was self-reported and is shown in Table 1. Forty-two percent of the population were 40^9, 48% were 50-69, and 9% were over 70 years of age. Although all three racial/ethnic groups were represented at both clinics, 98% of Puerto Rican women presented at clinic 1, 94% of African-American women presented to clinic 2, and 81% of non-Latinas presented to clinic 2. Twenty-five percent of the women were currently employed, and 76% had household incomes less than $10,000 per year. Eighty-five percent of Puerto Rican women had a household income less than $10,000 compared to 74% of non-Latinas and 68% of African-American women (p=0.01). According to self-report, 37% of Puerto Rican women were mar ried or living with someone at the time of the interview compared to 22% of African-American women and 19% of non-Latinas (p=0.01). Interestingly, over half (56%) of the Puerto Rican women received less than an eighth-grade education compared to 17% of non-Latinas and 11% of African-American women (p<0.001). Based on self-report, non-Latinas were more likely to be uninsured compared to African-American women and Puerto Rican women, i.e., 16.5%, 7.1%, and 4.2%, respectively (p<0.001).

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The study population included women 40 years of age and older who were established patients for at least one year (according to their medical record) attending two family practice health centers located in poor urban areas of Buffalo, NY. One health center served predominantly an African-American population and the other served a predominantly Puerto Rican population based on established practice demographics. Both sites provided a full spectrum of family practice, including gynecologic and obstetric care. The majority of mammograms were ordered by the primary care office but were completed at off-site locations.

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INTRODUCTION

Regular screening for breast and cervical cancer reduces cancer morbidity and mortality through early detection and treatment. Yet, many women are not receiving these screening tests in accordance with recommended guidelines. For example, poor, uneducated women are less likely to receive mammography and Pap smears compared to women of greater socioeconomic status. Similarly, Latinas are less likely to receive screening in accordance with recommended guidelines than non-Latinas. Minority women continue to have lower incidence rates but higher mortality rates compared to white women.

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Enlist the help of local pharmacists and encourage patients to ask pharmacists about their medications and ADR

Physicians should remember that they have a good source of drug information in local pharmacists. Patients as well as physicians should actively interact with pharmacy personnel to obtain drug information. Physicians should work with local pharmacists to minimize medication errors. This becomes especially important in patients who see other physicians and use multiple pharmacies. Physician-pharmacist interaction should be made to work for the good of our patients.

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Take a drug history/document drug allergy

A poor drug history may lead to a failure to detect unintended drug effects. A drug history should include the use of alternative medicines or herbal medications, supplements and other over-the-counter (OTC) medications. A recent study indicated that review and documentation of nonprescription substances are uncommon in primary practice. Of 655 physician respondents, only 47% documented herbal and other alternative treatments in the medical record. Physicians should always ask patients about allergies to drugs and should make sure the allergy history has been clearly documented and prominently displayed on the front of the patient’s chart. When a doctor prescribes a new medication, he/she should always be sure to ask if the patient has used the drug before and if any unpredictable reaction occurred. Physicians should encourage patients with serious allergic reactions to wear medic alert bracelets or necklaces.

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Update knowledge of therapeutics

Three key factors were listed by the IOM that contribute to prescribing error: 1) using the wrong drug name, 2) incorrect dosage calculations, and 3) atypical or unusual and critical dosage frequency. It is very easy to use the wrong drug name when prescribing, because so many new drugs enter the market every year. The FDA Center for Drug Evaluation and Research (CDER) approved 98 original new drugs in 2000. There are more than 17,000 trade and generic names for pharmaceuticals marketed in North America. Keeping up-to-date and being ready to address drug-related questions posed by patients is becoming increasingly challenging.

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