Improving Female Preventive Health Care Delivery Through Practice Change: An Every Woman Matters Study

Abstract

Background:The levels of breast and cervical cancer screening in Nebraska primary care remain suboptimal despite awareness of their importance, and despite implementation of the Every Woman Matters program to assist low-income women. The GAPS model was used to develop a practice-based intervention to identify and reduce barriers to delivery of breast and cervical cancer screening services.Methods: Seven primary care practices actively participated in this multimethod case study. A research nurse collected data and facilitated the intervention process at each site. Qualitative data from field notes, patient encounters, and in-depth interviews of physicians and key informants were collected to describe the process of Papanicolaou and mammogram service delivery, and to identify barriers/facilitators to screening, and potential change areas. Chart reviews provided information regarding the preintervention and postintervention identification/execution of Papanicolaou smears and mammograms. Qualitative and quantitative analyses led to individual practice case studies. Cross case comparisons identified common themes.Results: The individual practice plans for change had many commonalities, ie, developing screening databases and reminder systems. The biggest differences involved practice contexts. Despite use of the GAPS model and a financial incentive to obtain "buy in" from providers and staff, change was difficult for all but 2 of the practices.

Guidelines for the Primary Prevention of Stroke

“…There is ample evidence that primary prevention measures are underused in general practice. [703][704][705] Although adherence rates to national recommendations for the treatment and control of cardiovascular risk factors are improving, there is still a large treatment gap. 95,706,707 Across the United States, the adherence rate for the treatment of hypertension is 61%; only 35% of those treated have their hypertension under control.…”

“…711,712 A combination of techniques is usually necessary to improve adherence, including physician education, addressing physician inertia, audit and feedback of practice patterns, physician profiling, patient prompts, and outreach visits. 703,708,[711][712][713] Some general strategies to improve adherence in the outpatient setting, although relatively costly, are more consistently effective. These include computer-based clinical reminder systems, electronic medical records, 714,715 and tailored, multifaceted programs.…”

A Practice Improvement Intervention Increases Chlamydia Screening Among Young Women at a Women's Health Practice

“…Successfully changing practice behavior involves a team effort among providers and clinic staff, flexibility and willingness to change, and interventions tailored to each practice (Dietrich, Woodruff, & Carney, ; Goodwin et al, ). The preventive care‐focused goal setting/assessment/plan/start‐up (GAPS) model incorporates these concepts (Dietrich et al) and has been successfully applied to develop a practice‐based intervention to increase breast and cervical cancer screening services (Backer, Geske, McIlvain, Dodendorf, & Minier, ). The approach is a four‐step continuous quality improvement method: goal setting regarding preventive care, assessment of current preventive care processes and level of goal attainment, planning to modify existing routines and to implement improved routines that support preventive care, and starting and maintaining the improved practices.…”

Reasons why women choose a medical practice or a women’s health centre for routine health screening: worker and client perspectives

“…Several authors have identified that women often forget when screening is due and, therefore, inadvertently neglect timely screening (McPhee et al. 2002, Backer et al. 2005, Lovell et al.…”