Using a new patient process to improve breast care access.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 171-171
Author(s):  
Eleanor Miller ◽  
Jonathan Colon ◽  
Nancy O'Connor

171 Background: Access to timely care is of major focus in oncology. Clinicians and administration collaborated to improve the training and support for non medical staff involved in the new patient process at the breast center. The goal of the process was to improve upon the surgical triage of patient appointments for those with suspicious mammograms or newly diagnosed with breast cancer in less than one week, use the nurse practitioner clinics most effectively, and to triage other diagnoses and patients per updated guidelines, thereby increasing access to care. Methods: A new patient intake form was created with the assistance of IT and added to the electronic medical record as a tool for use by clinical and nonclinical staff. Clinicians and administration also met to update the new patient process forming a decision tree, which ultimately was developed into a manual. A series of in-services were held with scheduling and clinical staff for education and training. Education was also provided to refer patients with complex needs to the nurse navigator. Outcomes were measured by clinical and administrative staff. Results: Access to surgery clinics has improved for new breast patients since the process updates were implemented. Patients can be seen an average of 3.5 days sooner for both malignant and benign diagnoses. Access to the nurse practitioner clinic also improved by 9.4 days. Patients that are diagnosed within the health system can be seen within 3 days, and those that are diagnosed outside the system, within 7 days. Conclusions: It was the goal to improve access to the breast center by updating the intake and scheduling guidelines to see patients with a new diagnosis of breast cancer or other breast problems more quickly. Having guidelines that can be followed by clinical and non clinical staff promotes communication and collaboration, as well as a consistent approach among staff. In the future, the continued refinement of the new patient process and ongoing collaboration will further improve access to care.

2021 ◽  
Author(s):  
Elizabeth A Poindexter ◽  
Amanda Rodriguez ◽  
Timothy Switaj

ABSTRACT Virtual health and secure messaging gained newfound relevance in medicine during the coronavirus disease (COVID)-19 pandemic. For a military trainee health care clinic located on Joint Base San Antonio, the McWethy Troop Medical Clinic (TMC), implementation of virtual health and secure messaging services meant decreased risk of COVID-19 exposure for trainees and clinical staff. Through ongoing utilization, these services also made impacts to reduce loss of instruction time and improve access to care for the McWethy TMC trainee population. In defining the challenges, successes, and future implications for virtual health and secure messaging at the McWethy TMC, key lessons emerge for other military trainee clinics. The key concepts explored in this article are virtual health and secure messaging.


2018 ◽  
Vol 5 ◽  
pp. 233339281774340 ◽  
Author(s):  
Tammy Toscos ◽  
Maria Carpenter ◽  
Mindy Flanagan ◽  
Kislaya Kunjan ◽  
Bradley N. Doebbeling

Background: Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These “positive deviant” practices translate into organizational policies to improve health care access and patient experience. Objective: To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Participants: Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Methods: Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Results: Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient–provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. Conclusion: We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access.


Author(s):  
S. Joseph Sirintrapun ◽  
Ana Maria Lopez

Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient’s electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.


2021 ◽  
Vol 28 (1) ◽  
pp. e100351
Author(s):  
Victoria Alba Malek Pascha ◽  
Li Sun ◽  
Ramiro Gilardino ◽  
Rosa Legood

ObjectivesArgentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country’s Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare.MethodsA cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results.ResultsIt was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations.DiscussionTele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic.ConclusionThere is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.


Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2254
Author(s):  
Matteo Franchi ◽  
Roberta Tritto ◽  
Luigi Tarantini ◽  
Alessandro Navazio ◽  
Giovanni Corrao

Background: Whether aromatase inhibitors (AIs) increase the risk of cardiovascular (CV) events, compared to tamoxifen, in women with breast cancer is still debated. We evaluated the association between AI and CV outcomes in a large population-based cohort of breast cancer women. Methods: By using healthcare utilization databases of Lombardy (Italy), we identified women ≥50 years, with new diagnosis of breast cancer between 2009 and 2015, who started adjuvant therapy with either AI or tamoxifen. We estimated the association between exposure to AI and CV outcomes (including myocardial infarction, ischemic stroke, heart failure or any CV event) by a Cox proportional hazard model with inverse probability of treatment and censoring weighting. Results: The study cohort included 26,009 women starting treatment with AI and 7937 with tamoxifen. Over a median follow-up of 5.8 years, a positive association was found between AI and heart failure (Hazard Ratio = 1.20, 95% CI: 1.02 to 1.42) and any CV event (1.14, 1.00 to 1.29). The CV risk increased in women with previous CV risk factors, including hypertension, diabetes and dyslipidemia. Conclusions: Adjuvant therapy with AI in breast cancer women aged more than 50 years is associated with increased risk of heart failure and combined CV events.


2016 ◽  
Vol 19 (3) ◽  
pp. A292-A293
Author(s):  
H. Zaid ◽  
Y.M. Abbas ◽  
S. Abaza

2013 ◽  
Vol 16 (4) ◽  
pp. 670-681 ◽  
Author(s):  
Sheila F. Castañeda ◽  
Vanessa L. Malcarne ◽  
Pennie G. Foster-Fishman ◽  
William S. Davidson ◽  
Manpreet K. Mumman ◽  
...  

2018 ◽  
Vol 3 (1) ◽  
pp. 34-39
Author(s):  
Taher Abdullah Hawramy ◽  
Dara Ahmed Mohammed ◽  
Hasan Abdullah Ahmed

Breast cancer is the global health problem. It is the highest prevalent site-specific cancer in women throughout the world and the most common reason of death in middle age women,  following lung cancer. Up to 5% of breast cancers are caused by inheritance. Male breast cancer accounts for less than 1%. Mammography is the first imaging study to evaluate breast abnormalities, Ultrasound is particularly useful in young women with dense breasts. Core needle biopsy permits the analysis of breast tissue architecture and whether invasive cancer is present. To compare core needle biopsy and imaging, the accuracy of each modality for purpose of the diagnosis and their impact on preoperative planning before surgical treatment. A retrospective cohort study was performed in 70 cases of breast cancer during 2015-2017 at Slemani Breast Center/ Kurdistan region. Inclusion criteria any patient with diagnosed with breast cancer for whom core biopsy and imaging techniques (ultrasound and mammography) were done, Age 25 years and above. Exclusion criteria, a patient with breast mass who did not underwent: one of the two modalities, Age below 25 years, pregnant women. In the current study: mean age/year for the  participants were Mean age = 51.34 year ± 12.85 SD), Sixty-nine cases were female and one male. By core biopsy (97.1%) is positive for malignancy. In this study: results about 34.28% of BIRADS V (ultrasound)lesions proved to be positive for malignancy by core biopsy, 1.43% of BIRADS V were negative for malignancy and the association was statistically highly significant, for BIRADS III lesions 17.14% were proved as positive for malignancy by core biopsy. About 45.7% of BIRADS V (mammography were positive for malignancy by core biopsy and the associations were found to be statistically highly significant and for BIRADS III 12.85% of lesions were positive for malignancy by core biopsy. There was a statistically significant association between radiological investigation(ultrasound, mammography) and histopathological finding (core biopsy).  


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