Implementation of Telephone Support to Improve Cervical Cancer Screening Among Women Enrolled in a Ryan White Clinic: An Outcomes-Based Process Improvement Study Pubblico

Abstract

Purpose: Invasive cervical cancer and its precursor lesions are the most important gynecologic manifestations of human immunodeficiency virus (HIV) infection. Regular Papanicuolaou (Pap) testing is accepted as a critical strategy for early detection and timely treatment. A significant gap in adherence to cervical cancer screening exists among HIV positive women enrolled in Georgia's West Central Health District (WCHD) Ryan White Program (RWP). A clinical quality improvement strategy was implemented and its effect on cervical cancer screening was observed. The primary questions addressed were (1) What impact will implementation of a telephone care management system have on client completion of annual cervical cancer screening, and (2) What barriers prevent clients from maintaining up-to-date Pap smears? Methods: Women identified as overdue for Pap testing received a series of telephone support calls from a trained Prevention Care Manager (PCM) from September 2012 through December 2012. Inclusion and exclusion criteria were determined by the HIV/AIDS Bureau's (HAB) cervical cancer screening performance measure. Patient follow-up continued from January 2013 through December 2013. Data Analysis: Statistical analysis was performed by Minitab 17. The p control chart, or p chart, was used to allow visualization and analysis of process performance during the baseline, intervention, and post-intervention time periods. Patient barriers to Pap testing were assessed by the PCMs during the telephone support calls. Results: The proportion of women with due or overdue cervical cancer screenings decreased from 49% to 23% during the intervention. During the post-intervention period a steady increase in the proportion of women without documented up-to-date screening occurred, reaching a high of 54%. The most common barriers to maintaining up-to-date Pap status were concerns about cost, (lack of) transportation, and competing priorities. Summary: Intensive recruitment techniques and a combination of tailored strategies have the potential to promote adherence to cervical cancer screening. Patient barriers may be overcome with the implementation of well-designed interventions that are based on the characteristics of the particular patient and provider populations. Further research may be needed to understand the effect of time on persistence of an intervention's impact.

Table of Contents

Table of Contents Chapter I - Introduction Introduction and rational.................................................1 Problem Statement........................................................ 1 Theoretical Framework....................................................3 Purpose Statement.........................................................4 Research Questions........................................................4 Significance Statement...................................................4 Chapter II - Review of the Literature Introduction..................................................................5 Body of Review of Literature.............................................5 Summary of Current Problem and Study Relevance..............21 Chapter III - Methodology Introduction.................................................................23 Population and Sample...................................................24 Research Design...........................................................24 Procedures..................................................................25 Instruments.................................................................29 Plans for Data Analysis...................................................32 Limitations and Delimitations............................................33 Chapter IV - Results Introduction.................................................................35 Findings.......................................................................35 Other Findings...............................................................40 Summary......................................................................43 Chapter V - Conclusions, Implications, and Recommendations Introduction..................................................................44 Summary of Study..........................................................44 Conclusion....................................................................46 Implications and Recommendations....................................49 Tables..........................................................................51 Figures.........................................................................60 References....................................................................67 Appendix.......................................................................72

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	cervical cancer screening telephone support process improvement HIV/AIDS
Committee Chair / Thesis Advisor	Osburne, Robert Carl, Emory University
Committee Members	Katner, Harold, Mercer University School of Medicine
Partnering Agencies	Georgia state or local health department

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