Telephone Care Management To Improve Cancer Screening among Low-Income Women

A Randomized, Controlled Trial

  1. Allen J. Dietrich, MD;
  2. Jonathan N. Tobin, PhD;
  3. Andrea Cassells, MPH;
  4. Christina M. Robinson, MS;
  5. Mary Ann Greene, MS;
  6. Carol Hill Sox, Engr;
  7. Michael L. Beach, MD, PhD;
  8. Katherine N. DuHamel, PhD; and
  9. Richard G. Younge, MD, MPH
  1. From Norris Cotton Cancer Center and Dartmouth Medical School, Hanover, New Hampshire; Albert Einstein College of Medicine of Yeshiva University, Montefiore Medical Group, and Fordham Family Practice, Bronx, New York; and Clinical Directors Network, Mount Sinai School of Medicine, and Beth Israel Medical Center, New York City, New York.

    Abstract

    Background: Minority and low-income women receive fewer cancer screenings than other women.

    Objective: To evaluate the effect of a telephone support intervention to increase rates of breast, cervical, and colorectal cancer screening among minority and low-income women.

    Design: Randomized, controlled trial conducted between November 2001 and April 2004.

    Setting: 11 community and migrant health centers in New York City.

    Patients: 1413 women who were overdue for cancer screening.

    Intervention: Over 18 months, women assigned to the intervention group received an average of 4 calls from prevention care managers and women assigned to the control group received usual care. Follow-up data were available for 99% of women, and 91% of the intervention group received at least 1 call.

    Measurements: Medical record documentation of mammography, Papanicolaou testing, and colorectal cancer screening according to U.S. Preventive Services Task Force recommendations.

    Results: The proportion of women who had mammography increased from 0.58 to 0.68 with the intervention and decreased from 0.60 to 0.58 with usual care; the proportion who had Papanicolaou testing increased from 0.71 to 0.78 with the intervention and was unchanged with usual care; and the proportion who had colorectal screening increased from 0.39 to 0.63 with the intervention and from 0.39 to 0.50 with usual care. The difference in the change in screening rates between groups was 0.12 for mammography (95% CI, 0.06 to 0.19), 0.07 for Papanicolaou testing (CI, 0.01 to 0.12), and 0.13 for colorectal screening (CI, 0.07 to 0.19). The proportion of women who were up to date for 3 tests increased from 0.21 to 0.43 with the intervention.

    Limitations: Participants were from 1 city and had access to a regular source of care. Medical records may not have captured all cancer screenings.

    Conclusions: Telephone support can improve cancer screening rates among women who visit community and migrant health centers. The intervention seems to be well suited to health plans, large medical groups, and other organizations that seek to increase cancer screening rates and to address disparities in care.

    Article and Author Information

    • Acknowledgments: The authors thank Joseph P. Addabbo Family Health Center, Bedford Stuyvesant Family Health Center, Betances Health Center, Brownsville Multi-Service Family Health Center, East Harlem/Boriken Community Health Center, Family Physician Health Center, Montefiore Medical Group and Comprehensive Family Care Center, Morris Heights Community Health Center, Park Ridge Health Center, Ryan-NENA Community Health Center, Sunset Park Family Health Center Network, Urban Health Plan, and William F. Ryan Community Health Center.

    • Grant Support: By the National Cancer Institute (R01 CA-87776).

    • Potential Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Allen J. Dietrich, MD, Department of Community and Family Medicine, Dartmouth Medical School, 7250 Strasenburgh Hall, Hanover, NH 03755; e-mail, Allen.J.Dietrich{at}dartmouth.edu.

    • Current Author Addresses: Dr. Dietrich, Ms. Robinson, Ms. Greene, and Ms. Sox: Dartmouth Medical School, 7250 Strasenburgh Hall, Hanover, NH 03755.

    • Dr. Tobin and Ms. Cassells: Clinical Directors Network, Inc., 5 West 37th Street, 10th Floor, New York, NY 10018.

    • Dr. Beach: Department of Anesthesiology, Dartmouth Medical School, HB7900, Hanover, NH 03755.

    • Dr. DuHamel: Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1130, New York, NY 10029.

    • Dr. Younge: Montefiore Medical Group, 1 Fordham Plaza, Bronx, NY 10458.

    • Author Contributions: Conception and design: A.J. Dietrich, J.N. Tobin, C.H. Sox, K.N. DuHamel, R.G. Younge.

    • Analysis and interpretation of the data: A.J. Dietrich, J.N. Tobin, C.M. Robinson, M.A. Greene, M.L. Beach, K.N. DuHamel.

    • Drafting of the article: A.J. Dietrich, J.N. Tobin, C.M. Robinson, M.A. Greene, M.L. Beach.

    • Critical revision of the article for important intellectual content: A.J. Dietrich, J.N. Tobin, C.M. Robinson, C.H. Sox, K.N. DuHamel, R.G. Younge.

    • Final approval of the article: A.J. Dietrich, J.N. Tobin, A. Cassells, C.M. Robinson, M.A. Greene, C.H. Sox, M.L. Beach, K.N. DuHamel, R.G. Younge.

    • Provision of study materials or patients: A. Cassells.

    • Statistical expertise: J.N. Tobin, M.L. Beach.

    • Obtaining of funding: A.J. Dietrich, J.N. Tobin, A. Cassells.

    • Administrative, technical, or logistic support: A.J. Dietrich, J.N. Tobin, A. Cassells, C.M. Robinson, M.A. Greene, C.H. Sox.

    • Collection and assembly of data: A. Cassells, M.A. Greene.

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    1. Ann Intern Med April 18, 2006 vol. 144 no. 8 563-571
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