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Improving Mammography Screening Among the Medically Underserved

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A Capsule Commentary to this article was published on 24 January 2014

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.

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Acknowledgements

The authors would like to thank Ivory Davis, MSN and Cara Pugh, BSN, for their commitment to helping patients complete screening. This research was funded by the National Cancer Institute (R01- CA115869-05).

Conflict of Interest

The study authors have no potential conflicts of interest.

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Authors and Affiliations

  1. Department of Medicine and Pediatrics, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71130, USA

    Terry C. Davis PhD, Cristalyn Reynolds MA & Connie L. Arnold PhD

  2. Department of Preventive Medicine, Northwestern University, Chicago, IL, USA

    Alfred Rademaker PhD, Edson Carias BS & Dachao Liu MS

  3. South Carolina College of Pharmacy, Charleston, SC, USA

    Charles L. Bennett MD, PhD, MPH

  4. Hollings Cancer Center of the Medical University of South Carolina, Charleston, SC, USA

    Charles L. Bennett MD, PhD, MPH

  5. Arnold School of Public Health, Columbia, SC, USA

    Charles L. Bennett MD, PhD, MPH

  6. William Jennings Bryan Veterans Administration Medical Center, Columbia, SC, USA

    Charles L. Bennett MD, PhD, MPH

  7. Division of General Internal Medicine, Northwestern University, Chicago, IL, USA

    Michael S. Wolf PhD, MPH

Authors
  1. Terry C. Davis PhD
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  2. Alfred Rademaker PhD
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  3. Charles L. Bennett MD, PhD, MPH
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Correspondence to Terry C. Davis PhD.

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Davis, T.C., Rademaker, A., Bennett, C.L. et al. Improving Mammography Screening Among the Medically Underserved. J GEN INTERN MED 29, 628–635 (2014). https://doi.org/10.1007/s11606-013-2743-3

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  • DOI: https://doi.org/10.1007/s11606-013-2743-3

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