Online Program

Female Cancer Screening: A Comparison Among Patients Seen in Health Centers, Physician Offices, and Hospital Outpatients

Monday, November 2, 2015

Alek Sripipatana, PhD, MPH, Bureau of Primary Health Care, U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD
Leiyu Shi, DrPH, MBA, MPA, School of Public Health, Johns Hopkins University, Baltimore, MD
Background and Objectives: Cancer is one of the leading causes of morbidity and mortality in the nation. Regular screening is key to early cancer detection, especially for vulnerable groups. The objective of this study was to determine rates of female cancer screening, based on national recommendations, for four key measures of interest across different primary care settings.

Research Design and Measures: Data from the latest National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) were used. Prevalence rates for mammograms, breast, pelvic, and pap examinations were calculated. Odds ratios were used to compare the likelihood cancer screening, after controlling for socioeconomic and regional factors. Differences in screening were assessed between physician offices (POs), health centers (HCs), and hospital outpatient departments (OPDs), as well as by key patient characteristics of interest.

Results: In unadjusted analyses, POs reported higher levels of breast examination, pelvic examination and pap tests than HCs and OPDs (p<.01). HCs recorded significantly higher rate of mammograms than both POs and OPDs (p<.05). Even after controlling for relevant covariates, POs showed a greater likelihood of performing breast, pelvic, and pap examinations compared to HCs (p<.05). OPDs show 60 percent lower likelihood of mammography, breast, pelvic, and pap examinations than HCs (p<.01). Differences in screening measures also existed by age, race, insurance type, patient status, number of chronic conditions, education, urban residence and region (p<.05).

Conclusions: Our study reveals significant disparities in cancer screening by care setting, as well as several socioeconomic factors. Safety-net primary care providers must do a better job at appropriately testing patients for cancers in order to make diagnoses as early as possible, in an effort to reduce mortality in vulnerable groups.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
Assess rates of female cancer screening, based on national recommendations, for four key measures of interest across different primary care settings. Evaluate individual and institutional factors associated with female cancer screening across different primary care settings.

Keyword(s): Preventive Medicine, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an Abstract Author because I am the co-investigator on the project and have done numerous similar projects before.
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.