Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial.
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.


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


METHODS
11 community and migrant health centers in New York City.


METHODS
1413 women who were overdue for cancer screening.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Dietrich
Allen J
AJ
Norris Cotton Cancer Center and Dartmouth Medical School, Hanover, New Hampshire 03755, USA. Allen.J.Dietrich@dartmouth.edu
Tobin
Jonathan N
JN
Cassells
Andrea
A
Robinson
Christina M
CM
Greene
Mary Ann
MA
Sox
Carol Hill
CH
Beach
Michael L
ML
DuHamel
Katherine N
KN
Younge
Richard G
RG
D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology* / Q000517:prevention & control*; D009519:New York City; D011203:Poverty; D013689:Telephone; D002583:Uterine Cervical Neoplasms / Q000208:ethnology / Q000517:prevention & control