How FQHCs Can Improve Mammography Screening Rates Among the Medically Underserved
The American Cancer Society reports that breast cancer is the second leading cause of cancer-related death among women in the United States. For 30 years, efforts to reduce breast cancer-related deaths have focused on early detection through self-examinations and annual mammograms. Although mammography rates have increased dramatically during the last three decades, they still remain persistently lower among disadvantaged populations. Many low-income women may have no health insurance, lower health literacy and/or education levels. Reducing these disparities in mammography screening has become a national public health priority.
Numerous studies have identified factors that impact breast cancer screening rates among disadvantaged populations. One major contributing factor is limited health literacy, which presents as poor knowledge about the screening process, failure to understand screening benefits, and an absence of physician screening recommendations. Other factors may include inadequate transportation, lack of health insurance, and poor availability of local screening facilities.
A recent study by the National Institutes of Health focused specifically on developing interventions for populations at higher risk for not undergoing a mammogram—patients who receive care at inner-city Federally Qualified Health Centers (FQHCs). These government-supported clinics provide care to more than 20 million people regardless of insurance status and are strategically located in areas designated as being medically underserved. The study examined the effectiveness of three different strategies designed to improve FQHCs’ mammography screenings rates and to:
Strategy 1: Enhance care that provides assurance that patients receive a screening recommendation and access to a mammogram
Strategy 2: Provide literacy-informed education materials
Strategy 3: Utilize those materials along with RNs to provide support, appointment scheduling and follow-up
The focus group consisted of three groups of the same size with common demographics. At the conclusion of the study, 55.7% of the group using strategy 1 completed a mammogram, while just 51.8% of the group utilizing only the education materials completed a mammogram. However, nearly two-thirds (65.8%) of those utilizing strategy 3 that combined the educational materials with support and follow-up by a nurse completed a mammogram.
The study continued by explaining that when the nurses called patients, the most common barrier given by patients was the inability to make the appointment rather than additional decision-making or cancer-related anxiety. This provides strong evidence that providing telephone follow-up reminders and, if needed, rescheduling assistance for no-cost mammograms effectively reduces key barriers for mammography completion for low income women.
Adding additional nursing staff to implement Strategy 3 support and follow-up program can be a challenging and costly endeavor—especially for FQHCs. One simple and significantly cost-effective solution would be for FQHCs to partner with a medical call center to provide initial education, follow-up and appointment scheduling. This solution provides FQHCs access to a staff of specially-trained RNs available 24/7/365 to provide these services at a fraction of the cost required to hire and employ in-house staff.
Most importantly, it provides access to needed preventative and follow-up care to a large number of high-risk women in medically underserved areas to ensure that they can be screened and potentially treated for one of the deadliest—and most common—diseases.