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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Randomized Controlled Trial of Mammography Intervention in Insured Very Low–Income Women

Nasar U. Ahmed, Gillian Haber, Kofi A. Semenya and Margaret K. Hargreaves
Nasar U. Ahmed
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Gillian Haber
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Kofi A. Semenya
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Margaret K. Hargreaves
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DOI: 10.1158/1055-9965.EPI-10-0141 Published July 2010
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Abstract

Background: 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).

Methods: 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.

Results: 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).

Conclusions: 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.

Impact: 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. Cancer Epidemiol Biomarkers Prev; 19(7); 1790–8. ©2010 AACR.

Footnotes

  • Note: This article is dedicated to the late Robert Hardy, M.D., M.P.H., Professor of Internal Medicine, Oncology, for his leadership in the development of the intervention strategies.

  • Received February 5, 2010.
  • Revision received April 26, 2010.
  • Accepted May 10, 2010.
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Cancer Epidemiology Biomarkers & Prevention: 19 (7)
July 2010
Volume 19, Issue 7
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Randomized Controlled Trial of Mammography Intervention in Insured Very Low–Income Women
Nasar U. Ahmed, Gillian Haber, Kofi A. Semenya and Margaret K. Hargreaves
Cancer Epidemiol Biomarkers Prev July 1 2010 (19) (7) 1790-1798; DOI: 10.1158/1055-9965.EPI-10-0141

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Randomized Controlled Trial of Mammography Intervention in Insured Very Low–Income Women
Nasar U. Ahmed, Gillian Haber, Kofi A. Semenya and Margaret K. Hargreaves
Cancer Epidemiol Biomarkers Prev July 1 2010 (19) (7) 1790-1798; DOI: 10.1158/1055-9965.EPI-10-0141
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