The Reminder is making its archives back to 2003 available on our website. Please note that, due to technical limitations, archive articles are presented without the usual formatting.
A new study funded by the Canadian Population Health Initiative (CPHI) and the Canadian Health Services Research Foundation (CHSRF) has found that the rate of poor, rural women undergoing mammograms more than doubled when a breast screening program was brought directly to them. The study found that more women in Manitoba took advantage of preventive health care after transportation and cultural barriers were removed Ð rates increased from 20% in 1995 to more than 45% in 1999. To evaluate the specific effects of the new breast screening program, the study also compared breast-screening rates with participation in two other prevention services, childhood immunization and cervical cancer screening (Pap tests). Participation in both those services was substantially unchanged over the study period. The study, published this month in the American Journal of Public Health, was led by Sumit Gupta and Leslie Roos, from the Manitoba Centre for Health Policy at the University of Manitoba. The breast screening program was created in 1995 by CancerCare Manitoba, with funding from the Government of Manitoba. It has three permanent sites serving the cities of Winnipeg, Brandon, and Thompson. In addition, mobile screening mammography vans travel the province, reaching 50 smaller communities each year as well as targeting high-need neighbourhoods in Winnipeg. Visits by the clinic-on-wheels are promoted with letters sent to eligible women and follow-up letters for those who do not respond, as well as publicity through the media, local public health offices, and community centres. "It's a common-sense solution: if the client doesn't come to you, bring the service to her," says lead researcher Leslie L. Roos, from the Manitoba Centre for Health Policy. "This is an important initiative, because access barriers are a longstanding concern for many preventive services. Passive approaches, where a provider waits for clients to come in for services, tend to under-serve poorer people and those in rural areas, especially for prevention. See 'Barriers' P.# Con't from P.# That's a double whammy, because those are the people who generally have the greatest burden of health problems, and benefit the most from prevention services. This program shows that the public system can break down barriers by taking some of the responsibility for accessing services upon itself, instead of the traditional model where that responsibility rests entirely with the client." The program improved screening rates across the board, with gains among women in cities as well as rural areas, and in all income groups. Gains were particularly strong in rural areas, almost eliminating disparities in access between women at the top and bottom of the income scale. Despite some improvement, the rate for poor urban women still lagged behind the other groups in 1999, at less than 40%. Previous research has found that provinces with organized screening programs tend to have higher mammography rates, but did not focus on the distribution of the gains. "This kind of outreach initiative gives better health care to people who need it, and it has a larger significance as well," says Carmen Connolly, Director of the Canadian Population Health Initiative, which co-funded the study. "It shows that innovation within the public system can address some of the most basic challenges facing providers and communities, by providing services in new ways. We need to look closely at initiatives like this to see how they work, and share the results." The study was funded by the Canadian Population Health Initiative (part of the Canadian Institute for Health Information) and the Canadian Health Services Research Foundation. The Manitoba Centre for Health Policy also receives funding from the Government of Manitoba.
