Elmer T. Whitler

Effectiveness of Community Health Workers in Providing Outreach and Education for Colorectal Cancer Screening in Appalachian Kentucky

The purpose of this study was to examine the effectiveness of a community health worker (CHW)–delivered cancer education program designed to increase knowledge and awareness of colorectal cancer screening options. The study population was an extremely vulnerable and medically underserved geographic region in Appalachian Kentucky. CHWs enrolled participants in face-to-face visits, obtained informed consent, and administered a baseline assessment of knowledge of colorectal cancer risks and the benefits of screening and screening history. An educational intervention was then provided and participants were re-contacted 6 months later when a posttest was administered. The mean score of the 637 participants increased from 4.27 at baseline to 4.57 at follow-up (p < .001). Participants who reported asking their health care provider about colorectal cancer screening increased from 27.6% at baseline to 34.1% at follow-up (p = .013). Results suggest that CHWs were very effective at maintaining the study population; no loss to follow-up occurred. The results also showed increased knowledge and awareness about colorectal cancer screening education. Implications for social work practice, policy and research are discussed.

Meeting the Need of a Rural State for Primary Care Physicians: A Health Care Reform Challenge

Objective: Determine current and projected needs for primary care physicians in Kentucky and explore education and workforce policies that can contribute to overcoming physician shortages. Methods: Need and demand for physicians were estimated using an adaptation of the Physician Supply Model and Physician Requirements Model developed by US Health Resources and Services Administration. Data sources included the Kentucky Board of Medical Licensure, Area Resource File, US Census Small Area Health Insurance Estimates, Kentucky State Data Center, and National Resident Matching Program. Results: Between 1527 and 1888 additional primary care physicians are required to meet projected needs and demands by 2020. These requirements are substantially more than current supply trends suggest will be available. Conclusion: No single policy can solve the shortage of primary care physicians; therefore, multiple approaches must be used at the local, state, and national levels. A new system of care, patient centering, to reform the health care system is also suggested.