Corey H. Brouse

Association Between Prescription Co-Payment Amount and Compliance With Adjuvant Hormonal Therapy in Women With Early-Stage Breast Cancer

PURPOSE Noncompliance with adjuvant hormonal therapy among women with breast cancer is common. Little is known about the impact of financial factors, such as co-payments, on noncompliance. PATIENTS AND METHODS We conducted a retrospective cohort study by using the pharmacy and medical claims database at Medco Health Solutions. Women older than age 50 years who were taking aromatase inhibitors (AIs) for resected breast cancer with two or more mail-order prescriptions, from January 1, 2007, to December 31, 2008, were identified. Patients who were eligible for Medicare were analyzed separately. Nonpersistence was defined as a prescription supply gap of more than 45 days without subsequent refill. Nonadherence was defined as a medication possession ratio less than 80% of eligible days. RESULTS Of 8110 women younger than age 65 years, 1721 (21.1%) were nonpersistent and 863 (10.6%) were nonadherent. Among 14,050 women age 65 years or older, 3476 (24.7%) were nonpersistent and 1248 (8.9%) were nonadherent. In a multivariate analysis, nonpersistence (ever/never) in both age groups was associated with older age, having a non-oncologist write the prescription, and having a higher number of other prescriptions. Compared with a co-payment of less than

Telephone Outreach to Increase Colorectal Cancer Screening in an Urban Minority Population

30, a co-payment of

Patient Preferences and Adherence to Colorectal Cancer Screening in an Urban Population

30 to

Barriers to Colorectal Cancer Screening With Fecal Occult Blood Testing in a Predominantly Minority Urban Population: A Qualitative Study

89.99 for a 90-day prescription was associated with less persistence in women age 65 years or older (odds ratio [OR], 0.69; 95% CI, 0.62 to 0.75) but not among women younger than age 65, although a co-payment of more than

Facilitating Factors for Colorectal Cancer Screening

90 was associated with less persistence both in women younger than age 65 (OR, 0.82; 95% CI, 0.72 to 0.94) and those age 65 years or older (OR, 0.72; 95% CI, 0.65 to 0.80). Similar results were seen with nonadherence. CONCLUSION We found that higher prescription co-payments were associated with both nonpersistence and nonadherence to AIs. This relationship was stronger in older women. Because noncompliance is associated with worse outcomes, future policy efforts should be directed toward interventions that would help patients with financial difficulties obtain life-saving medications.

Contrasts between didactic and Deweyan approaches to health education

OBJECTIVES We compared the effectiveness of a telephone outreach approach versus a direct mail approach in improving rates of colorectal cancer (CRC) screening in a predominantly Black population. METHODS A randomized trial was conducted between 2000 and 2003 that followed 456 participants in the New York metropolitan area who had not had recent CRC screening. The intervention group received tailored telephone outreach, and the control group received mailed printed materials. The primary outcome was medically documented CRC screening 6 months or less after randomization. RESULTS CRC screening was documented in 61 of 226 (27.0%) intervention participants and in 14 of 230 (6.1%) controls (prevalence rate difference=20.9%; 95% CI = 14.34, 27.46). Compared with the control group, the intervention group was 4.4 times more likely to receive CRC screening within 6 months of randomization. CONCLUSIONS Tailored telephone outreach can increase CRC screening in an urban minority population.

Promoting Discussions about Cultural Competence in an Undergraduate Health Course.

We measured patient preferences for colorectal cancer (CRC) screening strategies and actual receipt of alternative CRC screening tests among an urban minority sample participating in an intervention study. The fecal occult blood test was the most preferred test, reportedly owing to its convenience and the noninvasive nature. For individuals who obtained a test that was other than their stated preference (41.1%), reasons for this discordance may be due to physician preferences that override patient preferences.

A Pilot Study of Instructor Factors and Student Preferences

Colorectal cancer is the second leading cause of cancer death in the United States.1 Appropriate screening can reduce incidence of and mortality from colorectal cancer.2–5 The US Preventive Services Task Force recommends that all average-risk individuals aged 50 years and older receive colorectal cancer screening.6 The American Cancer Society recommends several acceptable approaches to screening, including an annual 3-card home fecal occult blood test.7 The Healthy People 2010 objective is to increase the proportion of people aged 50 and older who have received a fecal occult blood test within the preceding 2 years to at least 50%.8 Lack of knowledge, confidence, and skills; negative attitudes toward the tests themselves; fear of the consequences of screening; and inadequate social support all have been suggested as possible barriers to colorectal cancer screening,9 whereas positive attitudes toward colorectal cancer screening and physician encouragement have been associated with receipt of a fecal occult blood test with a home stool kit.10 Despite these studies, gaps remain in what is known about barriers to successful interventions to increase colorectal cancer screening, particularly in minority populations.11,12 This study is based on the assumption that identification and definition of barriers to colorectal cancer screening in low-income, underserved minority populations can help guide the development of effective interventions.

Knowledge, beliefs, and barriers relevant to colorectal cancer screening in an urban population: a pilot study.

Background. In this retrospective study, we examined factors that facilitated receipt of colorectal cancer (CRC) screening in a sample of low-income, predominantly African Americans participating in a tailored telephone education intervention. Methods. A total of 61 individuals who received CRC screening were matched on age and sex with 61 individuals who had not received screening. Using records collected as part of the intervention, we identified facilitating factors and compared them between groups. Results. We identified 8 facilitating factors, of which there were significant bivariate relationships with 6 factors. These 6 factors were stated familiarity with CRC test, seemed to only need reminder calls, seemed ready to screen, primary care physician (PCP) encouraged CRC screening, had an upcoming PCP appointment, and being prevention oriented. Conclusions. Identifying facilitating factors in those who receive screening may lead to insights about what factors need to be cultivated in those who do not receive screening.

Barriers to Colorectal Cancer Screening: An Educational Diagnosis

Purpose – Over the past few decades, several theories and models have evolved to guide health education practice. Some of these models are participatory and democratic; nevertheless, much health education practice is based on achieving goals established by “health authorities,” which are called here the didactic model. The purpose of this paper is to consider that model and contrast it with a Deweyan model, based on the pragmatist philosopher, John Dewey.Design/methodology/approach – First provides a historical perspective on the didactic and Deweyan models stressing their implications for health education. The didactic approach is contrasted with a dialectical approach implied by the Deweyan model. Then briefly discusses pragmatism and cognition noting the importance of emotions in the learning process and consider the implications of various philosophical perspectives for understanding human behavior. The final two sections discuss the goals of health education and the role of the health educator based ...