262897 Impact of health-related legal needs on timely care among women with abnormal cancer screening

Monday, October 29, 2012 : 9:24 AM - 9:42 AM

Sarah W. Primeau, MSW , Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA
Karen M. Freund, MD, MPH , Associate Director for Research Collaboration, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
Sharon M. Bak, MPH , Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA
Joseph N. Palmisano, MA, MPH , School of Public Health, Boston University, Boston, MA
Timothy Heeren, PhD , Biostatistics Department, Boston University School of Public Health, Boston, MA
Samantha Morton, JD , Medical-Legal Partnership | Boston, Boston Medical Center, Boston, MA
Tracy A. Battaglia, MD, MPH , Boston University School of Medicine, Boston, MA
Introduction: The presence of health-related legal needs, defined as adverse social circumstances with legal remedies that reside in laws, regulation or polices, may contribute to cancer disparities. For example, the denial of adequate food, housing or insurance may impact one's ability to engage in recommended care.

Methods: The Boston Patient Navigation Research Program collected data (2007-2008) for women with a breast or cervical cancer screening abnormality at 6 community health centers. This secondary analysis assesses the impact of legal needs on timeliness to diagnostic care, defined as resolution within 365 days from the abnormal screen. Legal needs were captured in 5 categories: income supports, housing and utilities, education and employment, legal status, and personal or family stability and safety.

Results: 1,493 women received navigation; mean age 39 years; 31% Hispanic, 27% Black, 32% White; 37% non-English speakers and 28% had private health insurance. Overall, 88 women (6%) had legal needs identified by the navigator. Compared to those without legal needs, those with were more likely to be younger (p=.001) and have public or no health insurance (p=.03). The association between presence of legal needs and time to resolution was found to be time-dependent. When controlling for age, race, insurance, language and care site, women with legal needs were less likely to resolve early on (60 day HR=.51 (0.393, 0.660)), though the effect diminished with follow-up time (180 day HR=0.81 (0.574, 1.135)).

Conclusion: The presence of health-related legal needs negatively impacts timely resolution of screening abnormalities, suggesting unmet needs despite navigation.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the impact of health-related legal needs to care among women in a Patient Navigation Research Program

Keywords: Barriers to Care, Cancer Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have my master’s degree in Social Work with a health care focus and am currently a public health student on a mentorship grant looking at health-related legal needs to cancer care among vulnerable populations. I work on several projects focused on reducing health care disparities and improving patient care and health outcomes among underserved populations. I am also involved in the resubmission of a grant for a Medical-Legal Barrier and Cancer Care study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.