Assessing Effective Strategies to Integrate Breast Care into Primary Care for Uninsured, Low-Income Women in Montgomery County Maryland

Introduction: Breast cancer screening rates are not at optimal levels for the poor and uninsured. Subsequently, the Primary Care Coalition implemented a breast healthcare patient navigation and provider training program to increase mammography referral rates and patient mammography screening rates within the Montgomery Cares safety-net clinics. Montgomery Cares safety net clinics provide primary care to ethnically diverse, low-income and uninsured adult residents of Montgomery County, MD

Methods: A comprehensive program was developed to address mammography screening and included the following:1) A breast health needs assessment which resulted in enhancements to the electronic medical record for tracking and reporting mammography screening within Montgomery Care clinics; 2) the development of a patient navigator program; and 3) the development of an online CME, “A Review of Breast Cancer Screening: The Role of Culture” that was made available to clinic staff.

Results: The mammography referral rate within safety-net clinics nearly doubled (from 35% to 66%; P≤.05) and mammogram screening rate more than doubled (from 15% to 32%; P≤.05) between baseline data collected in 2006 and data collected in 2008.

Conclusions: The program designed increased both mammogram referral and screening rates within low-income minority women. The strategies identified may be effective in other community-based health centers for increasing screening rates among underserved populations and may help reduce the health disparities seen for breast cancer.