Prevention Care Management

Higher screening rates for breast, cervical, and colorectal cancer could reduce cancer mortality rates substantially. Current cancer screening rates are particularly disappointing among ethnic minorities and individuals with low socioeconomic status who often present with late-stage diagnoses and have high mortality rates. Interventions are needed that increase cancer screening.

Prevention Care Management (PCM) is a centralized telephone care management system designed to increase cancer screenings among women aged 50-69. Women who are not up-to-date for cancer screenings receive phone calls from prevention care managers (i.e., provider agency staff, trained in PCM) who facilitate the screening process by addressing barriers that prevent or delay cancer screenings. 

During the phone calls, the prevention care managers use a structured script to provide motivational support, respond to each patient's specific barriers, facilitate the provision of written clinician recommendations for screenings, and provide patient activation cards to enhance the patient's ability to communicate with the clinician. The managers also schedule appointments, provide accurate information about screenings, prompt women with appointment reminder calls and letters, provide directions to screening facilities, and help women find a means of transportation to appointments.

The Prevention Care Management program requires the following support:

• One day of training for the Prevention Care Manager
• A four hour training for the medical record staff or health care provider who identifies the targeted patient
• An average of four telephone support calls from the Prevention Care Manager to the patient

Time required will vary according to the efficiency of the targeting procedure, and the number of patients targeted.

The intervention is targeted to women aged 50-69 and the health care providers that serve them.

The intervention is suitable for health care providers associated with urban community health centers who have sufficient access to medical records to allow for identification of women who are not up-to-date for cancer screenings.

Prevention Care Management: A Manual for Improving Breast, Cervical, and Colorectal Cancer Screening Rates for Women in Primary Care. Implementers should obtain the Prevention Care Management Manual, have access to medical records to identify women who are not up-to-date for cancer screenings, and should expect to incur costs for staff time to learn the procedure and to make phone calls.

Women were recruited for the study during routine visits to participating health centers or by clinician referral. The participants were minority and low-income women between 50 and 69 years of age who were overdue for at least one cancer screening (i.e., mammography, cervical, or colorectal). There were 873 Spanish-speaking women, 513 English-speaking women, and 4 Haitian Creole-speaking women. Participants were randomly assigned to an intervention group or a usual care control group. Over 18 months, women in the intervention group received an average of four calls from prevention care managers.

The outcomes included change in screening status for mammography, cervical cancer, and colorectal cancer, measured through the examination of medical records.

• Between baseline and follow-up, women in the intervention group who were up-to-date for one cancer screening increased by 5%, whereas women in the usual treatment group who were up-to-date for one cancer screening increased by only 1% (p<.017).

• Between baseline and follow-up, women in the intervention group who were up-to-date for two cancer screenings increased by 14%, whereas women in the usual treatment group who were up-to-date for two cancer screenings increased by only 1% (p<.017).

• Between baseline and follow-up, women in the intervention group who were up-to-date for three cancer screenings increased by 22%, whereas women in the usual treatment group who were up-to-date for three cancer screenings increased by 8% (p<.017).

• Between baseline and follow-up, women in the intervention group who were up-to-date for mammography screenings increased by 10% (p<.001). In contrast, women in the usual treatment group who were up-to-date on mammography screenings decreased by 2%, but this decrease was not statistically significant.

• Between baseline and follow-up, women in the intervention group who were up-to-date for cervical cancer screening increased by 7% (p<.001). In contrast, the percentage of women in the usual treatment group who were up-to-date on cervical cancer screenings did not change.

• Between baseline and follow-up, women in the intervention group who were up-to-date for colorectal cancer screening increased by 24% (p<.001). In contrast, women in the usual treatment group who were up-to-date on cervical cancer screenings increased by 11% (p<.05).