Improving Adherence to Public Health Follow-up Care Standards for Underserved Women with Abnormal Cervical Cytology

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Background and Review of Literature: Although the overall incidence of cervical cancer has declined over the past few decades, this disease persists, particularly among underserved, low-income, minority women. Patient navigators can assist this vulnerable population group to achieve recommended follow-up care after an abnormal screening test by identifying and eliminating barriers associated with social determinants of health (SDOH). “The Protocol for Responding to and Assessing Patient’s Assets, Risks, and Experiences”” (PRAPARE) is an evidence-based standardized national social risk assessment tool that can be utilized in patient navigation programs in order to improve health outcomes. Purpose: The purpose of this quality improvement (QI) project was to implement a patient navigation program utilizing the PRAPARE-guided method to improve adherence to follow-up care standards in women with abnormal screening cervical cytology from rural public health clinics that serve low-income minority women. Methods: Show rates for four public health colposcopy clinics before and after the implementation of the PRAPARE intervention were measured and compared using Chi-Square analysis. The show rates included those appointments kept under usual follow-up care prior to the COVID-19 pandemic, appointments kept during the height of the COVID-19 pandemic, and those appointments kept after the implementation of PRAPARE-driven patient navigation. Implementation Plan/Procedure: PRAPARE-guided patient navigation, conducted by the primary investigator via phone calls and mail, allowed the navigator to recognize and respond to SDOH reported by the women that may have prevented them from adhering to public health follow-up care standards by providing them with community referrals and resources. PRAPARE-guided navigation was administered to 37 participants scheduled to received abnormal cervical cytologic follow-up care at four county colposcopy clinic sites over a three-month period. Results: Pre-COVID and COVID colposcopy clinic show rates under usual follow-up care were measured and compared to the show rates of the clinics after implementation of PRAPARE-driven patient navigation for four county health departments. The show rates for each health clinic were combined and compared for an overall total using Chi-Square analysis. The overall analysis revealed statistical significance (p <.05) x² (6.182, p=0.012903) for pre-COVID show rates (71%) versus post implementation show rates (87%). The overall COVID show rates (71%) versus post implementation show rates (87%), x² (5.0173, p= 0.024301) were also statistically significant. Conclusions: Adherence to recommended follow-up was improved in the patient cohort following evidence-based patient navigation. By utilizing a team approach, patient navigation programs in the public health setting have the potential to improve cervical disease outcomes, reduce the incidence and mortality rates of cervical cancer, and reduce costs associated with treatment.

abnormal cervical cytology, adherence, barriers to care, cancer cervical cancer, diagnostic resolution, folow-up care, patient navigation, patient navigators, patient navigation program, PRAPARE, public health, social determinants of health