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Social Service Barriers Delay Care Among Women with Abnormal Cancer Screening

Byline: Sarah W. Primeau (1), Karen M. Freund (2), Ambili Ramachandran (1), Sharon M. Bak (1), Timothy Heeren (3), Clara A. Chen (4), Samantha Morton (5), Tracy A. Battaglia (1) Keywords: access to care; cancer; disparities; vulnerable populations Abstract: BACKGROUND Inequity in cancer outcomes for... Full description

Journal Title: Journal of General Internal Medicine 2014, Vol.29(1), pp.169-175
Main Author: Primeau, Sarah
Other Authors: Freund, Karen , Ramachandran, Ambili , Bak, Sharon , Heeren, Timothy , Chen, Clara , Morton, Samantha , Battaglia, Tracy
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 0884-8734 ; E-ISSN: 1525-1497 ; DOI: 10.1007/s11606-013-2615-x
Link: http://dx.doi.org/10.1007/s11606-013-2615-x
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recordid: springer_jour10.1007/s11606-013-2615-x
title: Social Service Barriers Delay Care Among Women with Abnormal Cancer Screening
format: Article
creator:
  • Primeau, Sarah
  • Freund, Karen
  • Ramachandran, Ambili
  • Bak, Sharon
  • Heeren, Timothy
  • Chen, Clara
  • Morton, Samantha
  • Battaglia, Tracy
subjects:
  • access to care
  • cancer
  • disparities
  • vulnerable populations
ispartof: Journal of General Internal Medicine, 2014, Vol.29(1), pp.169-175
description: Byline: Sarah W. Primeau (1), Karen M. Freund (2), Ambili Ramachandran (1), Sharon M. Bak (1), Timothy Heeren (3), Clara A. Chen (4), Samantha Morton (5), Tracy A. Battaglia (1) Keywords: access to care; cancer; disparities; vulnerable populations Abstract: BACKGROUND Inequity in cancer outcomes for minorities and vulnerable populations has been linked to delays in cancer care that arise from barriers to accessing care. Social service barriers represent those obstacles related to meeting life's most basic needs, like housing and income, which are often supported by public policy, regulation and services. OBJECTIVE To examine the association between social service barriers and timely diagnostic resolution after a cancer screening abnormality. DESIGN Secondary analysis of the intervention arm of Boston Patient Navigation Research Program (2007--2008) conducted across six urban community health centers. Subjects with no barriers, other barriers, and social service barriers were compared on their time to diagnostic resolution. SUBJECTS Women aY= 18 years of age with a breast or cervical cancer screening abnormality. MAIN MEASURES Social service barriers included: income supports, housing and utilities, education and employment, and personal/family stability and safety. Time to event analyses compared across five groups: those with no barriers, one barrier (other), one barrier (social service), two or more barriers (all other), and two or more barriers (at least one social service). KEY RESULTS 1,481 navigated women 31 % Hispanic, 27 % Black, 32 % White 37 % non-English speakers and 28 % had private health insurance. Eighty-eight women (6 %) had social service barriers. Compared to those without social service barriers, those with were more likely to be Hispanic, younger, have public/no health insurance, and have multiple barriers. Those with two or more barriers (at least one social service barrier), had the longest time to resolution compared to the other four groups (aHR resolution < 60 days=0.27, aY= 60 days=0.37). CONCLUSION Vulnerable women with multiple barriers, when at least one is a social service barrier, have delays in care despite navigation. The impact of patient navigation may never be fully realized if social service barriers persist without being identified or addressed. Author Affiliation: (1) Women's Health Unit, Section of General Internal Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University
language: eng
source:
identifier: ISSN: 0884-8734 ; E-ISSN: 1525-1497 ; DOI: 10.1007/s11606-013-2615-x
fulltext: fulltext
issn:
  • 1525-1497
  • 15251497
  • 0884-8734
  • 08848734
url: Link


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descriptionByline: Sarah W. Primeau (1), Karen M. Freund (2), Ambili Ramachandran (1), Sharon M. Bak (1), Timothy Heeren (3), Clara A. Chen (4), Samantha Morton (5), Tracy A. Battaglia (1) Keywords: access to care; cancer; disparities; vulnerable populations Abstract: BACKGROUND Inequity in cancer outcomes for minorities and vulnerable populations has been linked to delays in cancer care that arise from barriers to accessing care. Social service barriers represent those obstacles related to meeting life's most basic needs, like housing and income, which are often supported by public policy, regulation and services. OBJECTIVE To examine the association between social service barriers and timely diagnostic resolution after a cancer screening abnormality. DESIGN Secondary analysis of the intervention arm of Boston Patient Navigation Research Program (2007--2008) conducted across six urban community health centers. Subjects with no barriers, other barriers, and social service barriers were compared on their time to diagnostic resolution. SUBJECTS Women aY= 18 years of age with a breast or cervical cancer screening abnormality. MAIN MEASURES Social service barriers included: income supports, housing and utilities, education and employment, and personal/family stability and safety. Time to event analyses compared across five groups: those with no barriers, one barrier (other), one barrier (social service), two or more barriers (all other), and two or more barriers (at least one social service). KEY RESULTS 1,481 navigated women 31 % Hispanic, 27 % Black, 32 % White 37 % non-English speakers and 28 % had private health insurance. Eighty-eight women (6 %) had social service barriers. Compared to those without social service barriers, those with were more likely to be Hispanic, younger, have public/no health insurance, and have multiple barriers. Those with two or more barriers (at least one social service barrier), had the longest time to resolution compared to the other four groups (aHR resolution < 60 days=0.27, aY= 60 days=0.37). CONCLUSION Vulnerable women with multiple barriers, when at least one is a social service barrier, have delays in care despite navigation. The impact of patient navigation may never be fully realized if social service barriers persist without being identified or addressed. Author Affiliation: (1) Women's Health Unit, Section of General Internal Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, 801 Massachusetts Avenue, 1st floor, Boston, MA, 02118-2526, USA (2) Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street 63, Boston, MA, 02111, USA (3) Biostatistics Department, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118-2526, USA (4) Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118-2526, USA (5) Medical-Legal Partnership, 88 East Newton Street, Vose 5, Boston, MA, 02118, USA Article History: Registration Date: 26/08/2013 Received Date: 22/02/2013 Accepted Date: 07/08/2013 Online Date: 03/10/2013
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