Medical Inspection – Health Blog

Among participants in the study: 13% were 18 to 44 years old, 50% were 45 to 64 years old, and 37% were older than 65 years; 65% were women; 42% were married or coupled; 61% had completed high school education or higher; 39% were employed; 33% had annual household incomes <$10,000 and 65% had incomes < $25,000; 16% had no health insurance coverage; 89% had at least with 17% receiving education within the previous year; and 10% perceived difficulty getting care in the past year.

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The methods used in Project DIRECT are described in detail elsewhere. Briefly, the survey was conducted in 1997, among civilian, non institutionalized adults, aged >18 years, by using a multistage, population-based probability sample from census files in predominantly African-American neighborhoods in Raleigh and Greensboro, NC. All data were collected at baseline, before interventions were commenced, from both the intervention and control communities. Field interviewers visited each sample housing unit and selected eligible persons according to a specified protocol. Those selected were asked for a personal interview. The overall interview response rate was 87%. Participants (n=591) who met the following criteria were included in the cross-sectional analyses reported here: self-report of diabetes; being African American; and seeing a physician, nurse, or other health professional for any reason during the last year.

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Patient satisfaction is increasingly recognized as an important aspect of the quality of medical care. It is accepted that patient satisfaction is determined by many factors of care delivery, including communication among the patient, the provider, and the health care system; accessibility; availability; and convenience. For these reasons, patient satisfaction has been recently proposed as an indicator of the quality of diabetes care in the United States by the National Committee of Quality Assurance for the Diabetes Quality Improvement Project (DQIP)A However, the relationship between the process measures of the quality of diabetes care and patient satisfaction has not been examined to date.

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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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