 |
|
Cancer Early-Detection Services in Community Health Centers for the Underserved
A Randomized Controlled Trial
Allen J. Dietrich, MD;
Jonathan N. Tobin, PhD;
Carol Hill Sox, Engr;
Andrea N. Cassels, MPH;
Fredeswinda Negron;
Richard G. Younge, MD, MPH;
Neal A. Demby, DMD, MPH;
Tor D. Tosteson, ScD
Arch Fam Med. 1998;7:320-327.
Background Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations.
Design/Setting A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers.
Intervention Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement.
Evaluation End Points The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n=2645) and follow-up (n=2864) record review.
Results Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services.
Conclusions Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.
From the Department of Community and Family Medicine and The Norris Cotton Comprehensive Cancer Center, Dartmouth Medical School, Hanover, NH (Drs Dietrich and Tosteson and Ms Hill Sox); Clinical Directors Network Inc, New York, NY (Drs Tobin and Demby and Mss Cassels and Negron); the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Tobin); and the Department of Family Practice, State University of New York, Health Sciences Center, Brooklyn (Dr Younge). Ms Negron is now with HealthFirst PHSP Inc, New York; Dr Younge is now with The Bronx Health Plan, Bronx.
RELATED ARTICLES
Cancer Screening: A Challenge in Today's Changing Practice of Medicine
Roselyn Payne Epps
Arch Fam Med. 1998;7(4):315-316.
FULL TEXT
Can We Change Physicians' Practices in the Delivery of Cancer-Preventive Services?
Mack T. Ruffin IV
Arch Fam Med. 1998;7(4):317-319.
FULL TEXT
Practice Commentary
Mark A. Brown
Arch Fam Med. 1998;7(4):328.
FULL TEXT
Prescribe for Health: Improving Cancer Screening in Physician Practices Serving Low-Income and Minority Populations
Clara Manfredi, Ronald Czaja, Sally Freels, Mitchell Trubitt, Richard Warnecke, and Loretta Lacey
Arch Fam Med. 1998;7(4):329-337.
ABSTRACT
| FULL TEXT
A Patient-Initiated System for Preventive Health Care: A Randomized Trial in Community-Based Primary Care Practices
Robert B. Williams, Myde Boles, and Robert E. Johnson
Arch Fam Med. 1998;7(4):338-345.
ABSTRACT
| FULL TEXT
Physician and Patient Predictors of Health Maintenance Visits
John S. Preisser, Stuart J. Cohen, James L. Wofford, William P. Moran, Brent J. Shelton, Maureen W. McClatchey, and Pamela Wolfe
Arch Fam Med. 1998;7(4):346-351.
ABSTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Organizational Factors and the Cancer Screening Process
Anhang Price et al.
J Natl Cancer Inst Monogr 2010;2010:38-57.
ABSTRACT
| FULL TEXT
Interventions to Enhance Breast Cancer Screening, Diagnosis, and Treatment among Racial and Ethnic Minority Women
Masi et al.
Med Care Res Rev 2007;64:195S-242S.
ABSTRACT
Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial.
Dietrich et al.
ANN INTERN MED 2006;144:563-571.
ABSTRACT
| FULL TEXT
Informed patient consent to participation in cluster randomized trials: an empirical exploration of trials in primary care
Eldridge et al.
Clin Trials 2005;2:91-98.
ABSTRACT
Long-term Results From a Randomized Controlled Trial to Increase Cancer Screening Among Attendees of Community Health Centers
Roetzheim et al.
Ann Fam Med 2005;3:109-114.
ABSTRACT
| FULL TEXT
Adapting Psychosocial Intervention Research to Urban Primary Care Environments: A Case Example
Zayas et al.
Ann Fam Med 2004;2:504-508.
ABSTRACT
| FULL TEXT
A Randomized Controlled Trial to Increase Cancer Screening Among Attendees of Community Health Centers
Roetzheim et al.
Ann Fam Med 2004;2:294-300.
ABSTRACT
| FULL TEXT
Cancer Prevention Services and Physician Consensus in Primary Care Group Practices
Love et al.
Cancer Epidemiol. Biomarkers Prev. 2004;13:958-966.
ABSTRACT
| FULL TEXT
Practice based education to improve delivery systems for prevention in primary care: randomised trial
Margolis et al.
BMJ 2004;328:388.
ABSTRACT
| FULL TEXT
Effectiveness of Interventions to Increase Papanicolaou Smear Use
Yabroff et al.
J Am Board Fam Med 2003;16:188-203.
ABSTRACT
| FULL TEXT
Sun Protection Counseling for Children: Primary Care Practice Patterns and Effect of an Intervention on Clinicians
Dietrich et al.
Arch Fam Med 2000;9:155-159.
ABSTRACT
| FULL TEXT
Can we change physicians' practices in the delivery of cancer-preventive services?
Epps
Arch Fam Med 1998;7:315-316.
FULL TEXT
Can We Change Physicians' Practices in the Delivery of Cancer-Preventive Services?
Ruffin IV
Arch Fam Med 1998;7:317-319.
FULL TEXT
|
