选择退出式患者导航以改善无家可归女性的乳腺癌和宫颈癌筛查
Opt-Out Patient Navigation to Improve Breast and Cervical Cancer Screening Among Homeless Women.
作者信息
Asgary Ramin, Naderi Ramesh, Wisnivesky Juan
机构信息
1 Department of Medicine, New York University School of Medicine , New York, New York.
2 NYU Lutheran Family Health Center , Community Medicine Department, New York, New York.
出版信息
J Womens Health (Larchmt). 2017 Sep;26(9):999-1003. doi: 10.1089/jwh.2016.6066. Epub 2017 Jan 19.
BACKGROUND
A patient navigation model was implemented to improve breast and cervical cancer screening among women who were homeless in five shelters and shelter clinics in New York City in 2014.
MATERIALS AND METHODS
Navigation consisted of opt-out screening to eligible women; cancer health and screening education; scheduling and following up for screening completion, obtaining, and communicating results to patients and providers; and care coordination with social services organizations.
RESULTS
Women (n = 162, aged 21-74, 58% black) completed mammogram (88%) and Pap testing (83%) from baselines of 59% and 50%, respectively. There was no association between mental health or substance abuse and screening completion. Adjusted analysis showed a significant association between refusing/missing Pap testing and older age (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.04-1.20); independent predictors of mammogram included more pregnancies (OR 0.57, 95% CI 0.37-0.88) and older age (OR 0.84, 95% CI 0.79-0.90).
CONCLUSIONS
Opt-out patient navigation is feasible and effective and may mitigate multilevel barriers to cancer screening among women with unstable housing.
背景
2014年，在纽约市的五个收容所和收容所诊所中，实施了患者导航模式，以改善无家可归妇女的乳腺癌和宫颈癌筛查情况。
材料与方法
导航工作包括对符合条件的妇女进行主动筛查；癌症健康和筛查教育；安排并跟进筛查完成情况、获取结果并将结果告知患者和医疗服务提供者；以及与社会服务组织进行护理协调。
结果
女性（n = 162，年龄21 - 74岁，58%为黑人）的乳房X光检查完成率从基线时的59%提高到了88%，巴氏试验完成率从基线时的50%提高到了83%。心理健康或药物滥用与筛查完成情况之间没有关联。校正分析显示，拒绝/错过巴氏试验与年龄较大之间存在显著关联（比值比[OR] 1.12，95%置信区间[CI] 1.04 - 1.20）；乳房X光检查的独立预测因素包括更多的妊娠次数（OR 0.57，95% CI 0.37 - 0.88）和年龄较大（OR 0.84，95% CI 0.79 - 0.90）。
结论
主动式患者导航是可行且有效的，可能会减轻住房不稳定妇女在癌症筛查方面面临的多层次障碍。
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