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1.
JAMA Netw Open ; 3(1): e1920431, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-32003825

RESUMO

Importance: The internet is an important source of medical information for many patients and may have a key role in the education of patients about lung cancer screening (LCS). Although most LCS programs in the United States have informational websites, the accuracy, completeness, and readability of these websites have not previously been studied. Objective: To evaluate the informational content and readability of US LCS program websites. Design, Setting, and Participants: This cross-sectional study assessed US LCS program websites identified on September 15, 2018. A standardized checklist was used to assess key informational content of each website, and text was analyzed for reading level, word count, and reading time. Links to US websites of national advocacy organizations with LCS program content were tabulated. All functional LCS program websites in Google internet search engine results using the search terms lung cancer screening, low-dose CT screening, and lung screening were included in the analysis. Main Outcomes and Measures: Radiologists used a standardized checklist to evaluate content, and readability was assessed with validated scales. Website word count, reading time, and number of links to outside LCS informational websites were assessed. Results: A total of 257 LCS websites were included in the analysis. The word count ranged from 73 to 4410 (median, 571; interquartile range, 328-909). The reading time ranged from 0.3 to 19.6 minutes (median, 2.5; interquartile range, 1.5-4.0). The median reading level of all websites was grade 10 (interquartile range, 9-11). Only 26% (n = 66) of websites had at least 1 web link to a national website with additional information on LCS. There was wide variability regarding reported eligibility age criteria, with ages 55 to 77 years most frequently cited (42% [n = 108]). Only 56% (n = 143) of websites mentioned smoking cessation. The subject of patient cost was mentioned on 75% (n = 192) of websites. Although major LCS benefits, such as detection of lung cancer, were discussed by most (93% [n = 239]) websites, less than half of the websites (45% [n = 115]) made any mention of possible risks associated with screening. Conclusions and Relevance: There appears to be marked variability in the informational content of US LCS program websites, and the reading level of most websites is above that recommended by the American Medical Association and the National Institutes of Health. Efforts to improve website content and readability may be warranted.

2.
J Health Care Poor Underserved ; 31(1): 340-352, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32037335

RESUMO

Initial studies suggest that women living in U.S. territories may experience barriers to appropriate breast cancer diagnosis and treatment. Our purpose was to evaluate mammography screening engagement in U.S. territories compared with U.S. states. Women aged 50-74 years in the 2016 Behavioral Risk Factor Surveillance System survey without personal history of breast cancer were included. Proportions of women reporting mammography use were calculated. Multivariable logistic regression models were used to compare self-reported mammography use in U.S. territories with all U.S. states. Our total study population included 131,320 women. Of this group, 2,481 were from U.S. territories. In our adjusted analyses, women in the U.S. Virgin Islands were less likely to report mammography use (OR 0.52) compared with women in the U.S. states. Women in other U.S. territories reported mammography at similar rates to U.S. states. Targeted interventions accounting for unique, territory-specific barriers are likely required to improve screening engagement.

3.
J Am Coll Radiol ; 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31930983

RESUMO

OBJECTIVE: Tobacco use is the leading cause of preventable mortality in the United States. Screening mammography (SM) visits present opportunities for radiology practices to reduce tobacco-related morbidity and mortality. Our study evaluates implementation of a program that provides tobacco cessation service referrals and screens for lung cancer screening (LCS) eligibility among smokers presenting for SM at a community health center. METHODS: In 2018, two sets of questions were added to our SM patient intake questionnaire to assess (1) smoking history and (2) interest in referral to the health center-based tobacco cessation program for mailed information, telephone-based consultation, and in-person counseling. Primary outcomes were proportion of current smokers who requested a referral and of all smokers who were LCS-eligible. Bivariate logistic regression analyses compared sociodemographic characteristics of smokers who requested versus declined a referral. RESULTS: Of the 89.3% (1,907 of 2,136) who responded, 10.5% (201 of 1,907) were current and 29.1% (555 of 1,907) were former smokers. Of current smokers, 26.4% (53 of 201) requested referrals: mailed information by 23.9% (48 of 201), in-person counseling by 9% (18 of 201), and telephone-based consultation by 7.5% (15 of 201). No sociodemographic predictors for referral requests were identified. Of all smokers, 9.3% (70 of 756) were eligible for LCS, of which 31.4% (22 of 70) were up to date. CONCLUSION: One in ten women who underwent SM at our community health center were current smokers, of which one-quarter requested tobacco cessation referrals. Among LCS-eligible smokers, one-third were up to date. SM presents opportunities for radiology practices to advance population health goals such as tobacco cessation and LCS.

4.
AJR Am J Roentgenol ; 214(1): 59-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670590

RESUMO

OBJECTIVE. The purpose of this article is to assess the "reversed halo" sign in patients with septic pulmonary embolism (PE) due to IV substance use disorder. MATERIALS AND METHODS. A retrospective analysis was performed of chest CT scans obtained between 2007 and 2017 that had findings of septic PE associated with IV substance use disorder. Inclusion criteria were history of IV substance use disorder, findings of septic PE on chest CT scans, and confirmation of infection. Image analysis was performed by three radiologists to assess the frequency, appearance, and evolution of the reversed halo sign. Interreader agreement to characterize the reversed halo sign was assessed using kappa statistical analysis. The chi-square test was used to correlate reversed halo sign shape with evolution on follow-up scans. RESULTS. Of 62 patients who met the inclusion criteria (54.8% women; mean age, 32.8 ± 8.3 [SD] years), 59.7% (37/62) had reversed halo signs (κ = 0.837-0.958, p < 0.0001). The mean number of unique reversed halo signs per patient was 2.1 ± 1.7 (46.7% of patients had more than one reversed halo sign). Of 78 unique reversed halo signs, 93.6% (73/78) were peripherally located and 51.3% (40/78) were located at the lower lobe, 52.6% (41/78) were pyramidal and 47.4% (37/78) were round shaped, 89.7% (70/78) had central low-attenuation areas, and 34.6% (27/78) had internal reticulations. Cavitation developed in 37.2% (29/78) of reversed halo signs and more often in pyramid-shaped ones (70.8%, 17/24), whereas consolidation occurred in 30.8% (24/78) and more often in round-shaped ones (58.6%; 17/29, p = 0.03). CONCLUSION. Septic PE should be considered in the differential diagnosis of patients with IV substance use disorder presenting with reversed halo sign. The reversed halo sign was reliably and frequently observed on the chest CT scans of patients with IV substance use disorder-related septic PE. Characteristics of reversed halo sign presentation were identified as potential features to differentiate septic PE from other causes of pulmonary infarct manifesting with reversed halo sign.

6.
Eur J Radiol ; 119: 108639, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31442929

RESUMO

PURPOSE: To compare image quality and radiation doses for chest DECT acquired with dual-source and rapid-kV switching techniques. MATERIALS AND METHODS: Our institutional Review Board approved retrospective study included 97 patients (54 men, 43 women; 63 ±â€¯14 years) who underwent contrast-enhanced chest DECT with both single source, rapid kV-switching (SS-DECT) and dual source (DS-DECT) techniques per standard of care departmental protocols. Reconstructed images from both scanners had identical section thickness and section interval for virtual monoenergetic and material decomposition iodine (MDI) images. Two thoracic radiologists independently evaluated all DECT for findings, quality of images, perfusion defects (MDI), and presence of artifacts. Radiation dose descriptor, size-specific dose estimates (SSDE), was recorded. Data were analyzed with Wilcoxon Signed Rank and Cohen's Kappa tests. RESULTS: There were no significant differences in patient weight or SSDE for the two DECT techniques (p > 0.06). Both radiologists reported no difference in lesion and artifact evaluation on the virtual monoenergetic images from either technique (p > 0.05). However, SS-DECT (in 63-71/97 patients) had substantial artifactual heterogeneity in pulmonary perfusion on MDI images compared to none on DS-DECT (p < 0.001). CONCLUSION: Despite identical patients and associated radiation doses, there were substantial differences in material decomposition iodine images generated from SS-DECT and DS-DECT techniques. Pulmonary heterogeneity on MDI images from SS-DECT leads to artifactual areas of low perfusion and can confound interpretation of true pulmonary perfusion.


Assuntos
Tomografia Computadorizada Multidetectores/normas , Doses de Radiação , Radiografia Torácica/normas , Artefatos , Meios de Contraste , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/normas , Iodo , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Radiografia Torácica/métodos , Estudos Retrospectivos
7.
Psychiatr Serv ; 70(10): 927-934, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31357921

RESUMO

OBJECTIVE: Individuals with schizophrenia experience increased lung cancer mortality and decreased access to cancer screening and tobacco cessation treatment. To promote screening among individuals with schizophrenia, it is necessary to investigate the proportion who meet screening criteria and examine smoking behaviors, cancer risk perception, and receipt of tobacco cessation interventions from psychiatry and primary care. METHODS: The authors performed a cross-sectional survey and medical record review with 112 adults with schizophrenia treated with clozapine in a community mental health clinic (CMHC). RESULTS: Among older participants (ages 55-77 years) with schizophrenia, 34% met the criteria for lung screening on the basis of smoking history (heavy current or former smokers), and more than half believed they had a low risk of developing lung cancer. Of all participants, 88% had visited their primary care provider (PCP) in the past year; PCPs represented 35 different practices. Only one in three current smokers reported that their PCP or psychiatrist assisted them in obtaining medications for tobacco cessation. CONCLUSIONS: Given smoking history, many older adults with schizophrenia have potential to benefit from lung screening, yet most older participants underestimated their lung cancer risk. Although participants regularly accessed care, PCP and psychiatric visits may be missed opportunities to engage patients with schizophrenia in tobacco cessation and decrease preventable premature mortality. Embedding interventions in a CMHC, a centralized access point of care delivery for patients with schizophrenia, may have unique potential to increase uptake of cancer screening and tobacco cessation interventions.

8.
J Am Coll Radiol ; 16(10): 1433-1439, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31092347

RESUMO

PURPOSE: Millions of women undergo mammography screening each year, presenting an opportunity for radiologists to identify women eligible for lung cancer screening (LCS) with low-dose chest CT and smoking cessation counseling. The purpose of our study was to estimate the proportion of women eligible for LCS and tobacco cessation counseling among women reporting mammography screening within the previous 2 years using nationally representative cross-sectional survey data. METHODS: Women between the ages of 55 and 74 years in the 2015 National Health Interview Survey without history of lung or breast cancer who reported mammography use in the previous 2 years were included. The primary outcome was the weighted proportion of women eligible for LCS. Secondary outcomes included self-reported receipt of LCS and current smoking. Bivariate and multiple variable logistic regression analyses were performed to evaluate the association between primary and secondary outcomes and sociodemographics, accounting for complex survey design elements. RESULTS: Among 3,806 women meeting inclusion criteria, 7.1% were eligible for LCS and 9.8% were current smokers. Multivariable analyses demonstrated that LCS-eligible women were more likely to be white, younger, and non-college-educated and have lower household incomes (all P < .001). Among all LCS-eligible women, 58% reported undergoing mammography screening within the previous 2 years. Among LCS-eligible women who underwent screening mammography, 7.9% reported undergoing LCS. CONCLUSIONS: The majority of LCS-eligible women received mammography screening but did not receive LCS. Mammography encounters may represent prime opportunities to increase LCS participation among patients already receiving imaging-based screening services.

9.
J Am Coll Radiol ; 16(10): 1440-1446, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31092351

RESUMO

PURPOSE: To assess temporal trends and utilization patterns of diagnostic imaging performed for substance use disorder (SUD)-related indications in an academic radiology emergency department (ED). METHODS: Retrospective analyses of ED imaging examinations acquired from 2005 to 2015 were performed. Imaging examinations performed for suspected SUD-related indications, based on the order history, were compared with those without a SUD-related indication. Unadjusted analyses comparing demographic and imaging characteristics between SUD-related versus non-SUD-related indications used Wilcoxon and Pearson's χ2 tests. Multivariable logistic regression models, within each imaging modality subgroup and combined, were employed to examine the odds of imaging examinations having an SUD-related indication as a function of demographic and imaging characteristics. RESULTS: Among 938,245 examinations, 0.17% had an SUD-related indication. Patients with SUD-related indications were younger (mean 37.2 ± 11.1 versus 53.5 ± 22.4, P < .001) and more commonly male (65% versus 52%, P < .001). The proportions of MR (17%), spine (17%), and extremities (33%) studies performed for SUD-related indications were larger among SUD than non-SUD indications (6%, 8%, 26%, respectively, all P < .001). Regression analysis demonstrated the odds of acquiring an ED imaging examination with an SUD-related indication significantly increased over time (P < .001, adjusted odds ratio [aOR] = 1.06), which was most pronounced among MR (P < .001, aOR = 1.23). For all regression models, younger age, male gender, and body part being imaged were identified as independent predictors of an SUD-related indication for ED imaging. CONCLUSION: Imaging performed for an SUD-related indication represented a small but increasing subset of overall ED imaging. Utilization of MR for SUD-related indications significantly outpaced growth of MR without SUD-related indications.

11.
J Am Coll Radiol ; 16(4 Pt B): 580-585, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30947890

RESUMO

Disparities in outcomes exist for breast, colon, and lung cancer among diverse populations, particularly racial and ethnic underrepresented minorities (URMs) and individuals from lower socioeconomic status. For example, blacks experience mortality rates up to about 42% higher than whites for these cancers. Furthermore, although overall death rates have been declining, the differential access to screening and care has aggravated disparities. Our purpose is to assess how the coverage policies of CMS and the United States Preventive Services Task Force (USPSTF) influence these disparities. Additionally, barriers are often encountered in accessing screening tests and receiving prompt treatment. To narrow, and potentially eliminate, outcomes disparities, CMS and USPSTF could consider revising their decision-making processes regarding coverage. Some options include (1) extending their evidence base to include observational studies that involve groups at higher risk; (2) lowering the threshold ages for screening to encompass differences in incidence; (3) CMS approving screening CT colonography coverage, which can even increase compliance with other screening tests; (4) clarifying and streamlining guidelines; (5) supporting research on improving access to screening; and (6) encouraging the development of more navigation services for URMs.


Assuntos
Neoplasias da Mama/prevenção & controle , Neoplasias do Colo/prevenção & controle , Detecção Precoce de Câncer/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Cobertura do Seguro/estatística & dados numéricos , Neoplasias Pulmonares/prevenção & controle , Idoso , Detecção Precoce de Câncer/métodos , Grupos Étnicos/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores Socioeconômicos , Estados Unidos
12.
J Am Coll Radiol ; 16(4 Pt B): 596-600, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30947893

RESUMO

Lung cancer continues to be the leading cause of cancer mortality in the United States across all races and ethnicities, but it does not affect everyone equally. Individuals with serious mental illness (SMI), including schizophrenia and bipolar disorder, experience two to four times greater lung cancer mortality in part due to high rates of smoking, delays in cancer diagnosis, and inequities in cancer treatment. Additionally, adults with SMI experience patient, clinician, and health care system-level barriers to accessing cancer screening, such as cognitive deficits that impact understanding of cancer risk, higher rates of poverty and social isolation, patient-provider communication challenges, decreased access to tobacco cessation, and the fragmentation of primary care and mental health care. Despite the proven benefits and mandated coverage by public and private payers, lung cancer screening participation rates remain low among eligible patients, below 4% a year. Given disparities in other cancer screening modalities, these rates are likely to be even lower among individuals with SMI. This article provides a brief overview of current challenges in lung cancer screening and describes a pilot collaboration between radiology and psychiatry that has potential to improve access to lung cancer screening for individuals with serious mental illness.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Neoplasias Pulmonares/epidemiologia , Transtornos Mentais/epidemiologia , Adulto , Fatores Etários , Idoso , Atitude Frente a Saúde , Comorbidade , Grupos Étnicos , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Incidência , Neoplasias Pulmonares/diagnóstico , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Melhoria de Qualidade , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Análise de Sobrevida , Estados Unidos
13.
J Am Coll Radiol ; 16(4 Pt B): 631-634, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30947898

RESUMO

PURPOSE: One in five US women report that they have been victims of intimate partner violence (IPV) during their lifetime. With millions of women presenting for mammography every year, breast imaging centers may represent ideal venues to identify women at risk for IPV and refer them to appropriate support services. Our purpose was to evaluate implementation of a novel IPV screening and referral system for women presenting for mammography. METHODS: A question was added to intake questionnaire ("Do you feel safe in your home?") for adult women presenting for screening or diagnostic mammography from 2016 to 2017 at our hospital outpatient breast imaging sites. The proportion of women presenting for screening or diagnostic mammogram who felt unsafe was calculated. Bivariate logistic regression analyses were performed to compare baseline characteristics of women who stated that they felt unsafe at home versus women who did not state that they felt unsafe at home. RESULTS: In all, 99,029 examinations were performed (68,158 unique patients). Of these patients, 71 stated that they felt unsafe at home (71 of 68,158, 0.1%). Women presenting for their first mammogram were more likely to report feeling unsafe at home (odds ratio 3.03, 95% confidence interval 1.31-7.06, P = .01). No differences were found in age (P = .148), ethnicity (P = .271), gravida (P = .676), parity (P = .752), age at menarche (P = .775), and history of breast cancer (P = .726). CONCLUSIONS: Our results demonstrate the feasibility of a screening and referral system for IPV in radiology departments.


Assuntos
Neoplasias da Mama/diagnóstico , Violência por Parceiro Íntimo/prevenção & controle , Mamografia/métodos , Programas de Rastreamento/estatística & dados numéricos , Encaminhamento e Consulta , Inquéritos e Questionários , Centros Médicos Acadêmicos , Idoso , Intervalos de Confiança , Feminino , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Modelos Logísticos , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Comportamento de Redução do Risco , Estados Unidos
14.
Emerg Radiol ; 26(4): 427-432, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31030393

RESUMO

PURPOSE: To determine the diagnostic accuracy and time savings of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol for detecting choledocholithiasis in patients visiting the emergency department (ED) for suspected biliary obstruction. METHODS AND MATERIALS: This retrospective study evaluated adult patients (ages 18+ years) visiting an academic Level 1 trauma center between January 1, 2016, and December 31, 2017, who were imaged with MRCP for suspected biliary obstruction. Patients were scanned with either a four-sequence A-MRCP protocol or a conventional eight-sequence MRCP (C-MRCP) protocol. Image acquisition and MRI room time were compared. The radiology report was used to determine whether a study was limited by motion or prematurely aborted, as well as for the presence of pertinent biliary findings. Diagnostic accuracy of A-MRCP studies were compared with any available endoscopic retrograde cholangiopancreatography (ERCP) report within 30 days. RESULTS: One hundred sixteen patients met inclusion criteria; 85 were scanned with the A-MRCP protocol (45.9% male, mean 57.4 years) and 31 with the C-MRCP protocol (38.7% male, mean 58.3 years). Mean image acquisition time and MRI room time for the A-MRCP protocol were significantly lower compared to those for the C-MRCP protocol (16 and 34 min vs. 42 and 61 min, both p < 0.0001). Choledocholithiasis was seen in 23.5% of A-MRCP cases and 19.4% of C-MRCP cases. Non-biliary findings were common in both cohorts, comprising 56.5% of A-MRCP cases and 41.9% of C-MRCP cases. 44.7% of A-MRCP patients received subsequent (diagnostic or therapeutic) ERCP (mean follow-up time 3 days), in which A-MRCP accurately identified choledocholithiasis in 86.8% of cases, with sensitivity of 85%, specificity of 88.9%, positive predictive value (PPV) of 89.5%, and negative predictive value (NPV) of 84.2%. In comparison, 38.7% of C-MRCP patients underwent ERCP (mean follow-up of 2.3 days) with an accuracy of 91.7%, sensitivity of 80%, specificity of 100%, PPV of 100%, and NPV of 87.5%. Only 4.7% of A-MRCP exams demonstrated motion artifact vs. 12.9% of C-MRCP exams. One study was prematurely aborted due to patient discomfort in the A-MRCP cohort while no studies were terminated in the C-MRCP cohort. CONCLUSION: An abbreviated MRCP protocol to evaluate for choledocholithiasis provides significant time savings and reduced motion artifact over the conventional MRCP protocol while providing similar diagnostic accuracy.


Assuntos
Colangiopancreatografia por Ressonância Magnética , Coledocolitíase/diagnóstico por imagem , Serviço Hospitalar de Emergência , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Support Care Cancer ; 27(6): 1985-1996, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30887125

RESUMO

PURPOSE: Recent advances in cancer treatment have resulted in greatly improved survival, and yet many patients in the USA have not benefited due to poor access to healthcare and difficulty accessing timely care across the cancer care continuum. Recognizing these issues and the need to facilitate discussions on how to improve navigation services for patients with cancer, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine (NASEM) held a workshop entitled, "Establishing Effective Patient Navigation Programs in Oncology. The purpose of this manuscript is to disseminate the conclusions of this workshop while providing a clinically relevant review of patient navigation in oncology. DESIGN: Narrative literature review and summary of workshop discussions RESULTS: Patient navigation has been shown to be effective at improving outcomes throughout the spectrum of cancer care. Work remains to develop consensus on scope of practice and evaluation criteria and to align payment incentives and policy. CONCLUSION: Patient navigation plays an essential role in overcoming patient- and system-level barriers to improve access to cancer care and outcomes for those most in need.


Assuntos
Neoplasias/terapia , Navegação de Pacientes/métodos , Humanos , Neoplasias/patologia
18.
J Am Coll Radiol ; 16(7): 908-914, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30737162

RESUMO

PURPOSE: Regular contact with a primary care physician (PCP) is associated with increased participation in screening mammography. Older studies suggested that PCP interaction may have a smaller effect on screening mammography uptake among racial and ethnic minorities compared with whites, but there is limited contemporary evidence about the effect of PCP interaction on screening mammography uptake across different racial and ethnic groups. The purpose of this study was to evaluate the association between PCP contact and longitudinal adherence with screening mammography guidelines over a 10-year period across different racial/ethnic groups. METHODS: This HIPAA-compliant and institutional review board-approved retrospective single-institution study included women between the ages of 50 and 64 years who underwent screening mammography in the calendar year of 2005. The primary outcome of interest was adherence to recommended screening mammography guidelines (yes or no) at each 2-year interval from their index screening mammographic examination in 2005 until 2015. Patients were defined as having a high level of PCP interaction if their PCPs were listed in the electronic medical record within the top three providers with whom the patients had the most visits during the study period. Generalized estimating equation models were used to estimate the effect of high PCP interaction on screening mammography adherence while adjusting for correlated observations and patient characteristics. RESULTS: Patients in the high PCP interaction group had increased longitudinal adherence to recommended screening mammography (adjusted odds ratio [OR], 1.51; 95% confidence interval [CI], 1.42-1.73; P < .001). This was observed in stratified analyses for all self-reported racial groups, including white (adjusted OR, 1.51; 95% CI, 1.36-1.68; P < .001), black (adjusted OR, 1.93; 95% CI, 1.31-2.86; P = .001), Hispanic (adjusted OR, 1.92; 95% CI, 1.27-2.87; P = .002), Asian (adjusted OR, 1.55; 95% CI, 1.01-2.39; P = .045), and other (adjusted OR, 2.18; 95% CI, 1.32-3.56; P = .002), with no evidence of effect modification by race/ethnicity (P = .342). Medicaid (adjusted OR, 0.41; 95% CI, 0.31-0.53) and self-pay or other (adjusted OR, 0.39; 95% CI, 0.27-0.56) insurance categories were associated with decreased longitudinal adherence to recommended screening mammography (P < .001 for both). CONCLUSIONS: High levels of PCP interaction result in similar improvements in longitudinal screening mammography adherence for all racial/ethnic minority groups. Future efforts will require targeted outreach to assist Medicaid and uninsured patient populations overcome barriers to screening mammography adherence.

19.
J Immigr Minor Health ; 21(6): 1313-1324, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30701427

RESUMO

Lung cancer is a leading cause of cancer death in Latinos. In a telephone survey, we assessed perceptions about lung cancer and awareness of, interest in, and barriers to lung screening among older current and former smokers. We compared Latino and non-Latino responses adjusting for age, sex, education, and smoking status using logistic regression models. Of the 460 patients who completed the survey (51.5% response rate), 58.0% were women, 49.3% former smokers, 15.7% Latino, with mean age 63.6 years. More Latinos believed that lung cancer could be prevented compared to non-Latinos (74.6% vs. 48.2%, OR 3.07, CI 1.89-5.01), and less worried about developing lung cancer (34.8% vs. 50.3%, OR 0.44, CI 0.27-0.72). Most participants were not aware of lung screening (44.1% Latinos vs. 34.3% Non-Latinos, OR 1.24, CI 0.79-1.94), but when informed, more Latinos wanted to be screened (90.7% vs. 67%, OR 4.58, CI 2.31-9.05). Latinos reported fewer barriers to lung screening.

20.
Radiology ; 290(2): 278-287, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30620258

RESUMO

Lung cancer remains the leading cause of cancer mortality in the United States. Lung cancer screening (LCS) with low-dose CT reduces mortality among high-risk current and former smokers and has been covered by public and private insurers without cost sharing since 2015. Patients and referring providers confront numerous barriers to participation in screening. To best serve in multidisciplinary efforts to expand LCS nationwide, radiologists must be knowledgeable of these challenges. A better understanding of the difficulties confronted by other stakeholders will help radiologists continue to collaboratively guide the growth of LCS programs in their communities. This article reviews barriers to participation in LCS for patients and referring providers, as well as possible solutions and interventions currently underway.


Assuntos
Detecção Precoce de Câncer , Acesso aos Serviços de Saúde , Neoplasias Pulmonares/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Padrões de Prática Médica
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