A nurse practitioner intervention to increase breast and cervical cancer screening for poor, elderly black women

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Abstract
Objective: To compare nurse practitioner (NP) and physician rates of breast and cervical cancer screening among poor, elderly black women. Design: A quasi-experimental design was used to compare pre- and postintervention annual screening rates. Rates were determined by medical record audits. Setting: Two urban public hospital primary care clinics served as the study sites. Patients: All women aged 65 years or more were eligible to participate. Interventions: Women were offered screening by a NP during a routine visit in the intervention site; a physician reminder system was used in the control site. Main results: Baseline annual screening rates were comparable in the two study sites. At the end of the study period, rates were significantly higher in the NP site, compared with the control. In the NP clinic, the annual rate of Pap tests increased to 56.9% from the baseline of 17.8%, and mammographies increased to 40% from 18.3%. In comparison, rates remained low in the control site, increasing only to 18.2% of women receiving Pap tests from a baseline of 11.8%, and remaining at 18% for mammography. Conclusions: Use of a NP to deliver same-day screening is an effective strategy to target poor, elderly black women for breast and cervical cancer screening. However, even with the substantial increases in rates obtained with the NP intervention, screening in this vulnerable population remains below nationally targeted levels.

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