コルポスコピーの欠席率と相応の不平等を減らすための介入の開発と試験実施:混合方法の研究
Allison Cowling1, Lisa Nevens1, Nicole Contogiorgi1
1Northumbria Healthcare Trust Public Health Office, North Tyneside General Hospital, North Tyneside, UK.
Lancet (London, England)
|November 24, 2023
まとめ
標的型の電話による介入により,特に若くて恵まれない患者の場合,コルポスコピーの欠席率が著しく減少しました. このアプローチは 子宮頸がんのスクリーニングの有効性を向上させ 健康上の不平等を軽減します
科学分野:
- 公衆衛生
- 婦人科
- 医療サービス研究
背景:
- 子宮頸がんは 低所得者層に不釣り合いな影響を及ぼし 貧しい地域や若年層では コルポスコーピーの非出席率が高くなります
- 子宮頸がんのスクリーニングにおける診断の遅延は,検知されていないか,遅れて治療されたがん前疾患につながり,スクリーニングの効果を低下させる可能性があります.
- コルポスコピーの出席の障壁を理解し対処することは,スクリーニングプログラムの有効性を向上させ,健康格差を減らすために不可欠です.
研究 の 目的:
- コルポスコピーの診察に 出席しない主な原因を調査する.
- コルポスコピーの診察の出席率を向上させるための標的型介入を開発し,試験的に実施する.
- コルポスコピーの欠席率,特に脆弱な集団への介入の影響を評価する.
主な方法:
- 定性的なデータは,コルポスコピーの診察に出席した,キャンセルした,または出席しなかった患者のインタビューを通じて収集されました.
- テーマ分析により,参加の主要な障壁と要因が特定され,実験的介入の設計にインパクトを与えた.
- 診察前に電話で連絡をとり 個人の診察の障壁を特定し,対処した.診察前にと診察後に 診察の欠席率を比較した.
主要な成果:
- 行政上の問題や 約束を忘れること,不安,仕事,子育て,交通のトラブルなど,出席の妨げとなった.
- 診察前の電話による試験介入は 予定の患者の65%に成功しました
- 介入前の10%から介入期間中の8%に減少した. 最も恵まれない地域の25歳から39歳の患者では 欠席率は20%から12%に減少しました
結論:
- 積極的な電話による介入は,コルポスコピーの出席の障害を効果的に解決し,欠席率を減少させます.
- 対象を絞った介入は 子宮頸がんのスクリーニングの有効性を向上させ,特に若年層や貧困層の健康格差を軽減する見込みを示しています.
- 研究対象の特定NHSトラストを超えて,より広範な環境でこれらの発見を検証するために,さらなる研究が必要である.
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