转诊到乳腺癌风险评估和预防诊所的不公平:一项混合方法研究
Claire B King1,2, Brittany L Bychkovsky1,3,4,5,6, Erica T Warner6,7
1Comprehensive Breast Health Center, Brigham and Women's Hospital, Boston, MA, USA.
BMC primary care
|August 25, 2023
概括
黑人,公共保险和非英语患者不太可能被转诊进行乳腺癌风险评估. 在初级保健中标准化风险评估可能会改善对乳腺癌个性化风险评估,教育和预防 (B-PREP) 计划的公平获取.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 乳腺癌发病率的种族和民族差异可能会因不平等地获得个性化查和预防而加剧.
- 布里格姆妇女医院 (BWH) 的乳腺癌个性化风险评估,教育和预防 (B-PREP) 计划旨在为高风险患者提供护理.
- 了解B-PREP的转介模式对于解决潜在的不平等至关重要.
研究的目的:
- 为了描述所指的患者之间的差异,B-PREP用于风险评估,而乳腺健康中心 (BHC) 用于良性疾病.
- 探索初级保健临床医师对影响B-PREP转诊模式的因素的观点.
主要方法:
- 电子健康记录和B-PREP临床数据 (2017-2020年) 的回顾性分析.
- 多变量分析以检查与B-PREP转介概率相关的关联.
- 与六家诊所的九名初级保健临床医生进行了半结构化采访.
主要成果:
- 与良性疾病相比,黑人,医疗补助/医疗保险患者以及那些偏爱非英语语言的人不太可能被转介进行风险评估.
- 临床医生报告了不一致的风险评估方法和对B-PREP计划的意识变化.
结论:
- 在一次单一场地评估中,根据种族,保险和首选语言观察到乳腺癌风险评估的转诊差异.
- 需要进一步的研究来验证这些发现在更大的群体中.
- 建议在初级保健机构进行干预以标准化乳腺癌风险评估,以提高公平性.
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