Bigby A, Potter J, Carlson K, Rabinovitz J, Behforouz H, Johnson P; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 5.
Office for Women, Family and Community Programs, Brigham and Women's Hospital, 75 Francis Street - Neville 202, Boston, MA 02115; Tel: (617) 732-5759; Fax: (617) 264-6309; E-mail: jbigby@partners.org
RESEARCH OBJECTIVE: While many health indicators have improved for white women (WW) this improvement is not seen uniformly among black or Hispanic women. The objective of the study is to evaluate differences in the process of care for WW and minority women (MW) in primary care faculty practices (FPs) at teaching hospitals in an urban setting. STUDY DESIGN: The collaborators agreed upon standards of care referring to published guidelines. The study design is a retrospective chart review to evaluate the performance and follow-up of Pap smears, mammograms, LDL cholesterol, and screening for domestic violence (DV). POPULATION STUDIED: Women who had at least two visits to the FPs from 10/97-10/99 were identified. Minority women were over sampled to ensure an adequate sample size. This is a report on a preliminary population of 387 women, aged 45-64 years. 45% of the women are black, 11% Hispanic, and 44% white. PRINCIPAL FINDINGS: The mean age of the MW was 55 yrs and of the WW was 54 yrs. MW had higher rates of hypertension (56% vs. 36%, p<0.0001) and diabetes (24% vs. 11%, p=0.002). MW and WW had similar rates of past coronary heart disease (CHD) and cervical cancer. MW were less likely to have a history of past breast cancer than WW (2% vs. 6%, p=0.03). MW were more likely to have had a mammogram (92% vs. 85%, p=0.03). MW and WW had the same rates of "no show" for scheduled mammograms (15% vs. 14%). 5% of MW and 10% of WW had abnormal mammogram results with high rates of documented follow-up (88% vs. 91%, p=0.63). MW and WW had similar Pap smear rates (78% vs. 73%, p=0.35). Of the women with CHD, 74% of MW and 38% of WW did not have a LDL measured (p=0.05). Of those with LDL, 60% of MW and 40% of WW had LDL <100 mg/dl. MW and WW had low rates of screening for domestic violence (6% vs. 11%, p=0.07). MW were less likely to have the same primary care physician during the study period. CONCLUSIONS: MW and WW had high rates of breast and cervical cancer screening and follow-up of abnormal results. MW had higher co-morbid conditions and were less likely to have LDL screening even when they had known CHD. Both MW and WW had low rates of documented screening for domestic violence. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Attention to traditional women's health issues, such as Pap smear and mammogram screening, appears to have had a favorable impact on screening rates and follow-up for all women. The high prevalence of co-morbid illnesses, such as diabetes and HTN in the MW population has implications for disability among 45-64 year old MW. Focus on guidelines for risk factor reduction for CHD, especially in high risk populations such as MW, is necessary to improve compliance with published guidelines. Similarly, the rate of screening for DV, as obtained from a chart review, is extremely low for MW and WW in spite of published reports of the high prevalence of this problem. Attention to cervical cancer and breast cancer screening does not guarantee attention to other important health issues in middle aged women, including those at risk for significant morbidity and mortality. PRIMARY FUNDING SOURCE: Foundations, Harvard Medical School Center of Excellence in Women's Health Research Fund
Publication Types:
Keywords:
- African Americans
- Breast Neoplasms
- European Continental Ancestry Group
- Faculty
- Female
- Hispanic Americans
- Humans
- Mammography
- Mass Screening
- Minority Groups
- Patient Compliance
- Uterine Cervical Neoplasms
- Vaginal Smears
- radiography
- hsrmtgs
Other ID:
UI: 102274278
From Meeting Abstracts