Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, HLS 588, Miami, FL 33199, USA.
Cancer Epidemiol Biomarkers Prev. 2010 Jul;19(7):1790-8. doi: 10.1158/1055-9965.EPI-10-0141. Epub 2010 Jun 29.
The expectation that insurance coverage mitigates health disparities and equalizes use of healthcare assumes that services are equally accessed; however, the insured low-income target population in this research had a mammography rate of 23.4%, well below the general population. Our objective was to determine the most effective intervention to improve mammography use in low-income women insured by a managed care organization (MCO).
The study was a randomized controlled trial. Participants were 2,357 women noncompliant with screening mammography randomly assigned to one of three groups: control (n = 786) received usual care; simple intervention (n = 785) received prompt letter from the MCO medical director; and stepwise intervention (n = 786) received the same prompt letter from the MCO; if noncompliant, a second prompt letter from their primary care physician and, if still noncompliant, counseling from lay health workers. Outcome was completion of screening mammography extracted from medical records.
Screening rates were 13.4% for the control, 16.1% for the simple intervention, and 27.1% for the stepwise intervention. Compared with the control, the primary care physician letter in the stepwise intervention increased the likelihood of screening by 80% [Relative Risk (RR) = 1.80; P < 0.001], and counseling tripled the likelihood of screening (RR = 3.11; P < 0.001).
Compared with the control and simple intervention, a stepwise intervention to increase mammography is effective in a target population of hard-to-reach, low-income, insured women.
The research provides evidence for the impact of stepwise interventions to improve cancer screening in low-income insured populations, although the screening rates remain well below those of the general population.
保险覆盖范围减轻健康差距和平等利用医疗保健的期望假设服务同样可以获得；然而，这项研究中的被保险的低收入目标人群的乳房 X 光检查率为 23.4%，远低于一般人群。我们的目标是确定最有效的干预措施，以提高受管理式医疗组织 (MCO) 保险的低收入女性的乳房 X 光检查使用率。
该研究是一项随机对照试验。参与者是 2357 名不符合筛查性乳房 X 光检查的女性，随机分为三组：对照组（n = 786）接受常规护理；简单干预组（n = 785）收到 MCO 医疗主任的即时信函；逐步干预组（n = 786）收到 MCO 的相同即时信函；如果仍未合规，他们的初级保健医生会再发一封即时信函，如果仍未合规，会由非专业医疗保健人员提供咨询。结果是从医疗记录中提取的筛查性乳房 X 光检查完成情况。
对照组的筛查率为 13.4%，简单干预组为 16.1%，逐步干预组为 27.1%。与对照组相比，逐步干预组中的初级保健医生信函增加了筛查的可能性 80%[相对风险 (RR) = 1.80；P < 0.001]，咨询将筛查的可能性增加了两倍（RR = 3.11；P < 0.001）。
与对照组和简单干预组相比，逐步干预措施可有效提高难以接触到的、低收入、受保女性的乳房 X 光检查率。
该研究为提高低收入参保人群癌症筛查率的逐步干预措施提供了证据，尽管筛查率仍远低于一般人群。
