In lieu of an abstract, here is a brief excerpt of the content:

  • Case Management Intervention in Cervical Cancer Prevention: The Boston REACH Coalition Women’s Health Demonstration Project
  • Cheryl R. Clark, MD, ScD , Nashira Baril, MPH , Angela Hall, Marycarmen Kunicki, MA , Natacha Johnson, Jane Soukup, MSc , Stuart Lipsitz, PhD , and JudyAnn Bigby, MD

What Is the Purpose of the Study?

  • • To evaluate a case management intervention for Black women that addressed social and medical obstacles to adequate cervical cancer screening in primary care settings.

What Is the Problem?

  • • Black women in Boston are more likely to die of cervical cancer than women of other races.

  • • Black women face social and medical barriers to cervical cancer screening, including financial concerns and lack of coordinated care in primary care settings.

  • • It is not known whether addressing social and medical barriers in primary care settings can improve cervical cancer screening for Black women.

What Are the Findings?

  • • We found that social factors were a large obstacle for women to overcome to receive adequate cervical cancer screening.

  • • We found that women without childcare were much less likely to obtain Pap smears regularly than women with childcare help.

  • • Women without insurance were less likely than women with insurance to get timely follow up for abnormal Pap smears.

  • • Having assistance from a case manager was most useful for women who said they had a recent Pap smear before entering the study.

Who Should Care Most?

  • • Primary care providers.

  • • Primary care clinic directors and administrators.

  • • Community health workers.

  • • Health services administrators. [End Page 221]

Recommendations for Action

  • • Primary care centers should ask patients about social barriers to accessing care with systematic screening tools. Case managers can be trained to conduct these assessments.

  • • Primary care centers should provide patient-centered health care access to improve Pap smear screening for Black women with childcare needs.

  • • Health care systems should monitor and report Pap smear usage with medical record data to improve our understanding of Pap smear use, and to gauge the effect of screening interventions for Black women.

  • • Better access to financial coverage for cervical cancer follow-up for abnormal results is needed to ensure adequate cervical cancer screening for Black women.

  • • It is necessary to address larger systems issues and policies that shape the social and economic environments that influence women’s lives to help Black women overcome barriers to accessing care to prevent cervical cancer. [End Page 222]

Cheryl R. Clark
Center for Community Health and Health Equity, Brigham and Women’s Hospital
Brigham and Women’s-Faulkner Hospitalist Program
Division of General Medicine and Primary Care, Brigham and Women’s Hospital
Boston REACH Coalition
Nashira Baril
Boston Public Health Commission
Boston REACH Coalition
Angela Hall
Boston REACH Coalition
Marycarmen Kunicki
Center for Community Health and Health Equity, Brigham and Women’s Hospital
Boston Public Health Commission
Boston REACH Coalition
Natacha Johnson
Center for Community Health and Health Equity, Brigham and Women’s Hospital
Boston REACH Coalition
Jane Soukup
Division of General Medicine and Primary Care, Brigham and Women’s Hospital
Stuart Lipsitz
Division of General Medicine and Primary Care, Brigham and Women’s Hospital
JudyAnn Bigby
Boston REACH Coalition
Executive Office of Health and Human Services, Commonwealth of Massachusetts
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