Routine cervical cancer screening has significantly decreased the mortality rate of cervical cancer. Today, cervical cancer predominantly affects those who are rarely or never screened. Government programs are in place to provide cervical cancer screening at little to no cost, yet screening rates remain suboptimal.
This project evaluated an evidence-based intervention to increase cervical cancer screening among underserved women in a federally qualified health center (FQHC). Female patients ages 21 to 65 years without history of hysterectomy (n=1,710) were sent reminders to their phones through the electronic health record (EHR). The message included educational material about the screening process and an announcement regarding government aid for free or reduced cost screening.
The number of patients who made an appointment after receiving the message was assessed two months later. In total, 156 responses were collected, and 28 patients made an appointment for screening. The most frequently observed category of Ethnicity was Hispanic/Latina (n = 24, 86%). The most frequently observed category of Insurance was Title X (n = 13, 46%). The observations for Age had an average of 41.04 (SD = 9.93). Using an EHR communication function to send motivational reminders has shown some promise for increasing cervical cancer screening, thereby reducing cervical cancer mortality among the underserved.
In the current age of modernization, the traditional way of living seems to be the way of the past. The Masai Mara Game Reserve, one of the world’s finest wildlife reserves, the nation's top tourist attractions became a big part of the Nation's economy post-independence after 1963. Seeing the potential of the tourism market, the Kenyan Government, back in 1960’s, passed various laws for land escheatment from the protected Maasai Reservation for key positions in politics (Olo-Dapash, 2001). This subsequently divided the Mara, allowed for foreign bodies to buy land, eventually leading to a rise in the cost of living. The traditional Maasai are currently fighting for a way to preserve their culture while still being able to live in their ancestral land. To combat high costs, many Maasai have turned to giving tours in the Mara as tour guides. The Maasai Education, Research, and Conservation (MERC) partnering with the Mara Guide Association created a facility, the Dopoi Center, to help the Maasai become independent. This research focuses on the limited medical facilities the Maasai have access to, and the feasibility of having a medical center at the Dopoi Center.
Methods: An academic detailing session was provided by the Florida Department of Health in Broward County to primary care providers (PCPs) at a private clinic in the Southeastern US. The Conceptual Model of Nursing and Population Health (CMNPH) and the Promoting Action on Research Implementation in Health Services Framework (PARIHS) were used as guides for project design and evidence-based practice implementation. There were five participants in the academic detailing session including: a physician, a physician assistant (PA), and three medical students. PCP PrEP knowledge, attitudes, and behaviors were measured using pre and post intervention surveys. PrEP prescription, HIV/Sexually Transmitted Infection (STI) screening, and HIV testing were measured using aggregate data queries for the time periods of four and eight weeks before and four and eight weeks after the educational intervention. No personal identifying information was obtained.
Results: Pre and post surveys were analyzed using Wilcoxon signed rank testing to examine differences between matched pairs of ordinal data. Significant PrEP screening and HIV/STI testing were analyzed pre and post intervention using paired t tests to compare pre and post intervention practices. Significant differences were found in the results (Z = 2.03, 1.84, and 1.83 respectively, p > 0.1) The academic detailing intervention significantly improved knowledge, attitudes, and behaviors of primary care providers and medical students regarding PrEP. The mean of active qualifying ICD 10 codes prior to the intervention versus post intervention were 5 (sd = 5.64) vs. 4.2 (sd = 4.87) respectively. No significant difference was found between active ICD 10 codes for patient visits before compared to after the intervention (t (9) = 1.12, p>.1).
Conclusions: This project found that academic detailing improved provider self-reported knowledge, attitudes, and behaviors regarding PrEP. However, self-reported survey scores were not correlated with changes in clinical practice based on ICD 10 codes. Additional clinical implications may include fostering clinical outreach and cooperation between the county health department and local primary care clinics. Further research is needed on the effects of PrEP academic detailing on clinical practice.