Victoria V. Anwuri

The Robert Wood Johnson Foundation Diabetes Initiative: demonstration projects emphasizing self-management.

PURPOSE The purpose of the Diabetes Initiative of the Robert Wood Johnson Foundation is to demonstrate feasible and sustainable approaches to promoting diabetes self-management in primary care and community settings. METHODS The Diabetes Initiative of the Robert Wood Johnson Foundation includes 14 demonstration projects in primary care settings and in community-clinical partnerships. Projects serve predominantly indigent populations from varied cultural and linguistic backgrounds in urban, rural, and frontier settings around the United States. This report describes the Initiative, its ecological perspective on self-management, and implications for program development, sustainability, and dissemination. RESULTS Ecological perspectives stress varied levels of influence ranging from individuals to communities and policies. Based on this, the Initiative has identified key resources and supports for self-management (individualized assessment, collaborative goal setting, enhancing skills, follow-up and support, community resources, and continuity of quality clinical care). Lessons learned include the central roles of community health workers, integration of healthy coping and attention to negative emotion and depression in self-management, community partnerships, approaches to ongoing follow-up and support, organizational factors in sustaining programs, and the utility of a collaborative learning network for program development. Sustainability stresses organizational and policy supports for the program. Dissemination of lessons learned will stress collaboration among interested parties, stimulating consumer understanding and demand for self-management services as central to diabetes care. CONCLUSIONS The Diabetes Initiative demonstrates that effective self-management programs and supports can be implemented in real-world clinical and community settings, providing models of worthwhile, sustainable programs.

Evolution of an academic–public library partnership

A partnership to improve access to health information via an urban public library system was established in St. Louis, Missouri, in 2011. A multiyear project was outlined that included an information needs assessment, a training class for public library staff, information kiosks at library branches for delivering printed consumer health materials, and a series of health-related programming. The partnership evolved to include social service and community organizations to carry out project goals and establish a sustainable program that met the health and wellness interests of the community.

Referrals among cancer services organizations serving underserved cancer patients in an urban area.

Significant racial, socioeconomic, and geographic disparities exist nationwide in cancer screenings, treatments, and outcomes. Differences in health and social service provision and utilization may contribute to or exacerbate these disparities. We evaluated the composition and structure of a referral network of organizations providing services to underserved cancer patients in an urban area in 2007. We observed a need for increased awareness building among provider organizations, broader geographic coverage among organizations, and increased utilization of tobacco cessation and financial assistance services.

Abstract A40: An institutional strategy to increase minority recruitment to therapeutic trials

Purpose: Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet NIH-mandated goals, strategies to increase participation are required. Here, we present a framework for institutional enhancement of minority clinical trial accrual that provides linkages to other interventions. We report implementation of this framework at the Siteman Cancer Center, an NCI-designated Comprehensive Cancer Center. Methods: We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: 1) leadership support, 2) center-wide policy change, 3) infrastructural process control, data analysis and reporting and 4) follow up with clinical investigators. The Protocol Review and Monitoring Committee (PRMC) reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities (PECaD) leads efforts for proportional accrual, supporting the system through data tracking and web tools. Results: Following implementation in 2005, minority accrual to trials (therapeutic and nontherapeutic) increased from 13.7% in 2005, to 14.4% in 2006,15.9% in 2007 and 16.8% in 2008. The “rolling average” minority cancer incidence at the Cancer Center during this four-year timeframe was 17.3%. There has been an increase in the number of minorities participating in clinical trials in the years 2005 to 2008 (from 346 to 630,82%) compared to a 43% increase in the number of Caucasians during the same time period. Minority accrual in therapeutic clinical trials increased from 11.4% to 14.6%. Conclusion: Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring accrual, offers a successful strategy that can be replicated in other cancer centers. This approach may also be extendable to other clinical and translational centers. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A40.

Abstract B17: Providing access and reducing barriers to mammography use in an underserved area

Purpose: A federally-qualified health care center (FQHC) and a university in St. Louis, MO have partnered to increase access and reduce barriers to mammography in an underserved area. The purpose of this study is 1. to assess the barriers to mammography use in this underserved population; 2. the proportion of women in this population who are uninsured and do not quality for governmental assistance; 3. the previous lack of compliance to mammography among the women currently being navigated. Background: Even though black women have higher rates of utilizing mammography services than that of white women in Missouri, black women9s mortality rate is much higher in comparison to other groups and it is steadily increasing. This data reflects the importance of continuing to encourage routine mammography use among minority and underserved women in accordance with screening recommendations. The female patient population of the target clinic is 87.0% black and has a disproportionate number of women who were due or overdue for a mammogram (87.7%). Methods: The FQHC, Betty Jean Kerr People9s Health Centers, has instituted a mammography screening program in one of its clinics that previously did not provide mammography services. The university, through the Program for the Elimination of Cancer Disparities, provides training in patient navigation as well as financial assistance for uninsured participants who do not qualify for governmental co-payment assistance. The patient navigator assists women, age 40 and over in determining their eligibility for financial assistance, scheduling appointments, as well as any follow-up services. If the participant is uninsured and does not qualify for co-payment assistance, a study voucher is provided. All navigated women are surveyed on barriers to mammography use as well as the date of their last mammogram. Results: To date, 309 women have been navigated through the clinic. 65% report cost as a barrier. 72% of the navigated women are uninsured. Among those uninsured, 13% also do not qualify for state co-pay assistance. Of the women currently navigated, 60% were non-compliant for a mammogram, having a mammogram over 1 year previously. Among these women, 53%, 21%, and 25% of women were non-compliant for 1, 2 and 3 or more years respectively. Conclusions: There is a need for increased access to mammography in underserved areas. Even when access is achieved, financial barriers remain. FQHCs can subsidize these services, however even co-payments can be financial barriers for some uninsured women and there is a proportion of uninsured women who do not qualify for governmental assistance for co-payment. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B17.