Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois 60608, USA.
J Womens Health (Larchmt). 2013 Jun;22(6):507-17. doi: 10.1089/jwh.2012.3590. Epub 2013 May 14.
Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care.
Data originated from 250 women in the intervention arm of the Chicago Patient Navigation Research Program (PNRP). The women had abnormal cancer screening findings and navigator encounters. Women were recruited from a community health center and a publicly owned medical center. After describing proportions of African American and Latina women experiencing particular barriers, logistic regression was used to explore associations between patient characteristics, such as race/ethnicity, and type of barriers.
The most frequent barriers occurred at the intrapersonal level (e.g., insurance issues and fear), while institutional-level barriers such as system problems with scheduling care were the most commonly recurring over time (29%). The majority of barriers (58%) were reported in the first navigator encounter. Latinas (81%) reported barriers more often than African American women (19%). Differences in race/ethnicity and employment status were associated with types of barriers. Compared to African American women, Latinas were more likely to report an intrapersonal level barrier. Unemployed women were more likely to report an institutional level barrier.
In a sample of highly vulnerable women, there is no single characteristic (e.g., uninsured) that predicts what kinds of barriers a woman is likely to have. Nevertheless, navigators appear able to easily resolve intrapersonal-level barriers, but ongoing navigation is needed to address system-level barriers. Patient navigation programs can adopt the PNRP barriers framework to assist their efforts in assuring timely follow-up care.
患有乳腺癌或宫颈癌异常的女性可能会遇到及时接受后续护理的障碍，从而导致癌症诊断延迟。全国范围内正在激增旨在识别和消除障碍以确保及时获得护理的患者导航计划。本研究使用系统框架来描述障碍，包括非裔美国女性和拉丁裔女性之间的差异；确定障碍的复发情况；并研究与后续护理障碍相关的因素。
数据来自芝加哥患者导航研究计划（PNRP）干预组的 250 名女性。这些女性的癌症筛查结果异常，并与导航员有过接触。女性是从社区卫生中心和一家公有制医疗中心招募的。在描述经历特定障碍的非裔美国女性和拉丁裔女性的比例后，使用逻辑回归来探讨患者特征（如种族/民族）与障碍类型之间的关联。
最常见的障碍发生在个人层面（例如，保险问题和恐惧），而随着时间的推移，机构层面的障碍（例如，安排护理方面的系统问题）最常反复出现（29%）。大多数障碍（58%）是在第一次与导航员接触时报告的。拉丁裔（81%）比非裔美国女性（19%）更常报告障碍。种族/民族和就业状况的差异与障碍类型有关。与非裔美国女性相比，拉丁裔更有可能报告个人层面的障碍。失业女性更有可能报告机构层面的障碍。
在一组高度脆弱的女性中，没有单一特征（例如，没有保险）可以预测女性可能遇到哪些类型的障碍。尽管如此，导航员似乎能够轻松解决个人层面的障碍，但仍需要持续的导航来解决系统层面的障碍。患者导航计划可以采用 PNRP 障碍框架来协助他们确保及时进行后续护理。
