Improving Female Preventive Health Care through Practice Change by Backer et al - Article Example

Improving Female Preventive Health Care through Practice Change I. Introduction Every Woman Matters (EWM) is a state operated but federally funded program promoting preventive breast and cervical cancer screening (Backer, Geske, Mcllvain, Dadendorf & Minier, 2005). According to the authors, the strategy chosen by EWM has been to raise awareness of the risk of breast and cervical cancers and make the program financially accessible to low-income women. According to the authors, “eligible women receive clinical breast examination, mammography, and a Papanicolaou smear test at reduced or no cost” (Backer et al., 2005, p. 401). The authors noted however that despite the reduced or no cost access to the program, “the level breast and cervical cancer screening falls short of the ideal” (Backer et al., 2005, p. 401). As a result, the program was examined using the GAPs model with GAPS standing for “goal-setting, assessing existing routines, planning the modification of routines, and providing support for these improvements” (Backer et al., 2005, p. 402). The authors described the study as multi-method: a qualitative study design was used to describe the process of changes that took place in the implementation of the program while quantitative audits on mammogram and Papanicolaou test data were used to measure the success that was assumed to be related with the practice. The data that was used to assess the program involved observational field notes, audio-taped interviews with physicians and key staff, and chart reviews of the last female patients from 19 to 64 found in the clinic. Backer et al. (2005) led respondents to identify potential reforms in the EWM that can improve screening rates and advance key reforms that must be instituted in the program. Respondents identified several initiatives that may improve screening rates. Firstly, it was suggested that a “summary of chare” chart that can make it easier to identify patients in need of screening. Secondly, it was proposed that a postcard system be developed to encourage patients who had undergone the screening program elsewhere to continue the screening program in their current location. Thirdly, it was suggested that the patient educational materials be more readily available. Fourthly, it was raised that the program creates a monthly computer-generated reminders for patients needing screening. Fifthly, it was proposed that a reminder system for patients be designed. Sixthly, it was recommended that a common fact sheet for all health providers be used. Finally, the recommendations were forwarded to increase the accessibility of the patient educational materials. Although these are the most practical recommendations of the research activity reported by Backer et al. (2005) in the discussion section of their papers, the authors focused on the theoretical aspects of their research initiative. In particular, Backer et al. (2005) stressed that their findings “support the concept of practices as unique, complex organizational systems” which may be hardly immediately relevant for the immediate and more important concern of improving clinical or public health strategies; improving strategies and service delivery to promote preventive breast and cervical cancer screening. One important insight discussed in the discussion section of their research is that most practices are sometimes unable to institute change because of inertia. In other words, what is currently practiced tends to be perpetuated as practitioners tend to resist the movement to change: without friction, a body at rest tends to be rest while a body in motion tends to be in motion. However, a systems change model such as the GAPS can promote vigilance for systems change (Backer et al., 2005). II. Recommendations for Improving Every Woman Matters Program On reviewing the material of Backer et al. (2005), it is easy to see where the EWM program was probably weak. Firstly, while the program provides reduced to zero fees for the screening, it will be difficult to deny that the charging fees can effectively screen out at least a portion of the population who may have been deterred to avail of the screening given that fees are charged. Thus, whenever state budget allows it, it may be useful to institute cancer and breast and cervical cancer screening program that would allow zero payments for the breast and cervical cancer screening. Secondly, a probable key weakness of the program is that the GAPS model was used only on patients and health workers of the program. It seems another group would have to be included in the research program or in the regular effort to assess the EWN based on the GAPS model. In my view, the application of the GAPS model must cover the women that belong to the target of the program but who, for one reason or another, failed or deliberately avoided being a part of the breast and cervical cancer screening program. In addition, it would be important to draw lessons from the best practices to improve the EWM Program. III. Best practices on cancer screening There are several materials on best practices that can be used to improve the EWM program. Of course, one’s own practices constitute a huge source of resources from which one can obtain lessons to improve public health services delivery and promotion of breast/cervical cancer screening program. One such material is the that one by the U.S. Department of Health and Human Services that was published as early as 1997 or about 8 years before the article of Backer et al. (2005). The material recommended the following for personnel to improve their capability to enlist women for breast cancer screening: incentive, tracking and reminder systems, training, and staff development. Note that as early as 1997 some of the recommendations of Backer et al. (2005) have already been recommended by the U.S. Department of Health and Human Services. In addition, the material recommended the following on public education so that screening for breast cancer can be improved: multiple media channel and use of television, radio, print media, billboards, signage, and special events. In addition, the following were recommended by the material to improve outreach: timing, lesbian outreach, corporate sponsorship, hotlines, mobile/portable mammography, wellness program, outreach workers, coalitions, partnerships, and techniques for measuring outcomes. It is easy to see that the Department of Health and Human Services material already contain a rich arsenal of tools that can be used to significantly improve the turnout of any breast and cervical screening program. Hannon (2008) strongly recommended the use of workplaces to improve cancer screening. Some of the techniques that Hannon (2008) recommended to improve the turnout for cancer screening rates were client reminders, one-on-one education, promotion of employee time off for screening, paid time off for recommended screening, promotion of free or low cost cancer screening such as for cervical cancer and the like. The materials cited here do not exhaust the list of the literature available that can improve our strategies to improve our outreach programs to promote screening for breast and cervical cancer among women. In this discussion, I cited only three materials, but a lot more are available in the library and in the internet. IV. Conclusion and Summary Based on the discussion of the foregoing discussion, it is easy to see that the basic point is that our study of our experience, as well as the study of the experience of others, would allow us to improve the strategies toward ensuring the largest turnout for breast and cervical cancers. We just have to work hard and be committed to what we do. References Backer, E., Geske, J., Mcllvain, H., Dadendorf, D. & Minier, W. (2005). Improving female preventive health care delivery through practice change. Journal of the American Board of Family Medicine, 18 (5): 401-408. Hannon, P. (2008). Interventions to improve cancer screening services. American Journal of Preventive Medicine, 35 (1): s10-s13. U.S. Department of Health and Human Services. (1997). Reaching women for mammography screening. U.S. Department of Health and Human Services: Centers for Disease Control and Prevention. Read More