RT Journal Article
SR Electronic
T1 Improving Female Preventive Health Care Delivery Through Practice Change: An Every Woman Matters Study
JF The Journal of the American Board of Family Practice
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 401
OP 408
DO 10.3122/jabfm.18.5.401
VO 18
IS 5
A1 Backer, Elisabeth L.
A1 Geske, Jenenne A.
A1 McIlvain, Helen E.
A1 Dodendorf, Diane M.
A1 Minier, William C.
YR 2005
UL http://www.jabfm.org/content/18/5/401.abstract
AB Background: The levels of breast and cervical cancer screening in Nebraska primary care remain suboptimal despite awareness of their importance, and despite implementation of the Every Woman Matters program to assist low-income women. The GAPS model was used to develop a practice-based intervention to identify and reduce barriers to delivery of breast and cervical cancer screening services.Methods: Seven primary care practices actively participated in this multimethod case study. A research nurse collected data and facilitated the intervention process at each site. Qualitative data from field notes, patient encounters, and in-depth interviews of physicians and key informants were collected to describe the process of Papanicolaou and mammogram service delivery, and to identify barriers/facilitators to screening, and potential change areas. Chart reviews provided information regarding the preintervention and postintervention identification/execution of Papanicolaou smears and mammograms. Qualitative and quantitative analyses led to individual practice case studies. Cross case comparisons identified common themes.Results: The individual practice plans for change had many commonalities, ie, developing screening databases and reminder systems. The biggest differences involved practice contexts. Despite use of the GAPS model and a financial incentive to obtain “buy in” from providers and staff, change was difficult for all but 2 of the practices.Conclusion: The complexity of practice context and its effect on change cannot be underestimated. Individual practice providers and staff are often unaware of the potential challenges, and unable/unwilling to overcome them.