Continuity of Care and the Use of Breast and Cervical Cancer Screening Services in a Multiethnic Community

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Abstract
Objective: To examine how continuity of care affects the use of breast and cervical cancer screening in a multiethnic population. Methods: All data came from a structured telephone survey of a population-based quota sample designed to determine the cancer prevention needs of multiethnic blacks and Hispanics in New York, NY, in 1992. The study included 1420 women of 7 racial/ethnic groups: US-born blacks, English-speaking Caribbean-born blacks, Haitian blacks, and Puerto Rican, Dominican, Colombian, and Ecuadorian Hispanics. The main outcome measures were ever and recently having had a Papanicolaou smear, clinical breast examination (CBE), or mammogram. Results: Among respondents who qualified for the survey on the basis of age and ethnicity, the refusal rate for completing the interview was 2.1%. Compared with women without a usual site of care, those with a usual site, but no regular clinician, were 1.56, 2.45 (P≤.01), and 2.32 (P≤.05) times as likely ever to have received a Papanicolaou smear, CBE, or mammogram, respectively, and 1.84, 1.92 (P≤.05), and 1.75 times as likely to have received a recent Papanicolaou smear, CBE, or mammogram, respectively. Compared with women without a usual site of care, women with a regular clinician at that usual site of care were 2.63 (P≤.01), 2.83 (P≤.01), and 2.30 (P≤.05) times as likely ever to have received a Papanicolaou smear, CBE, or mammogram, and were 2.00 (P≤.05), 2.65 (P≤.01), and 1.40 times as likely to have recently received a Papanicolaou smear, CBE, or mammogram, respectively (adjusted odds ratios). For uninsured women, presence of a usual site of care was associated with increases in recent use of cancer screening for all screening tests. Conclusions: There is a linear trend in increasing breast and cervical cancer screening rates when one goes from having no usual source of care, to having a usual source, and to having a regular clinician at that usual source. Emphasis on continuity of care, especially on usual source of care, may help to bridge the gap in access to cancer prevention services faced by minority women. Arch Intern Med. 1997;157:1462-1470