A Rapid Review of Interventions to Improve Care for People Who Are Medically Underserved with Multiple Sclerosis, Diabetic Retinopathy, and Lung Cancer
Abstract
:1. Introduction
- Among patients with multiple sclerosis/diabetic retinopathy/lung cancer, what kind of interventions have sought to address any point in the care continuum in order to improve health and reduce disparities in screening, diagnosis, access to treatment and specialists, adherence, and retention in care?
- Among patients with multiple sclerosis/diabetic retinopathy/lung cancer, what is the effectiveness of interventions that address any point in the care continuum to improve health and reduce disparities in screening, diagnosis, access to treatment and specialists, adherence, and retention in care?
2. Methods
2.1. Inclusion and Exclusion Criteria
2.2. Search Strategy
2.3. Data Extraction
2.4. Quality Assessment and Data Synthesis
3. Results
3.1. Multiple Sclerosis
3.1.1. Access to Treatments or Specialists
3.1.2. Adherence to Treatment
3.2. Diabetic Retinopathy
3.2.1. Screening
3.2.2. Diagnosis
3.3. Lung Cancer
3.3.1. Screening
3.3.2. Access to Specialists or Treatment
3.3.3. Diagnosis
3.3.4. Patient Adherence to Treatment
4. Discussion
4.1. Addressing Geographic Barriers to Care
4.2. Improving Health Literacy
4.3. Improving Social Cohesion
4.4. Decreasing Discrimination
4.5. Affordability of Care
4.6. Remaining Gaps
4.7. Strengths and Limitations of the Literature Included
4.8. Strengths and Limitations of the Present Review
4.9. Future Research and Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Patient n (%) | Organization * n (%) | System n (%) | Total N (%) | |
---|---|---|---|---|
Screening | 6 (22%) | 16 (59%) | 5 (19%) | 27 (63%) |
Diagnosis | 0 | 0 | 4 (100%) | 4 (9%) |
Access to Treatment | 2 (40%) | 0 | 3 (60%) | 5 (12%) |
Access to Specialists | 1 (33%) | 1 (33%) | 1 (33%) | 3 (7%) |
Adherence to Treatment | 4 (100%) | 0 | 0 | 4 (9%) |
Retention in care | 0 | 0 | 0 | 0 |
Patient (Disease, n) | Organization (Disease, n) | System (Disease, n) | |
---|---|---|---|
Screening | Decision aid (LC, 3) Education (LC, 3) | Automated phone reminder (DR, 1) Screening program (LC, 3) Patient navigator (LC, 1) QI with feedback (LC, 1) Comparison of screening methods (LC, 4) Telehealth (D, 6) | Awareness campaign (LC, 1) Mobile clinic (D, LC, 3) |
Diagnosis | None | None | AI interpretation of imaging (D, 2) Mobile clinic (D, 1) Medicaid expansion (LC, 1) |
Access to treatment | mHealth app (D, 2) | None | Multifaceted QI intervention (LC, 1) Medicaid expansion/insurance subsidy (MS, LC, 2) |
Access to specialists | Telehealth (MS, 1) | Molecular tumor board (LC, 1) | Palliative care referrals (LC, 1) |
Adherence to treatment | Multicomponent (MS, 2) Medication administration route (MS, 1) Companion presence (LC, 1) | None | None |
Author | Brief Intervention Description | Main Relevant Findings |
---|---|---|
Baird, 2020 [21] | Behavioral intervention delivered in two phases over six weeks per phase. Phase one focused on sitting less; phase two focused on moving more. | The intervention was safe and feasible; there was a small positive change in sedentary behavior. |
Cascione, 2018 [22] | Injectable versus oral disease-modifying therapies (DMTs) | At 48 weeks, there was higher adherence among those taking oral versus injectable DMTs. |
Hartung, 2020 [23] | Low-income subsidy for Medicare beneficiaries newly diagnosed with MS | Across demographics, those who received a low-income subsidy were more likely to initiate early self-administered DMT than those who did not have a low-income subsidy. |
Kinnett-Hopkins, 2018 [24] | Racially tailored exercise program for black persons with MS consisting of strength and aerobic activities, behavioral coaching materials, and supplemental content based on social cognitive theory | The intervention was feasible, effective, and safe; exercise behaviors increased in inactive participants. |
Plow, 2019 [25] | A physical activity intervention versus a physical activity intervention plus a fatigue self-management intervention. | Fatigue management improved fatigue and quality of life at 12 weeks compared with social support, but not physical activity. Physical activity improved on quality of life compared with social support at 12 weeks. |
Author | Brief Intervention Description | Main Relevant Findings |
---|---|---|
Abramoff, 2018 [26] | Trained site staff took images using nonmydriatic retinal camera and uploaded to the AI system | The AI system met the prespecified endpoints for superiority compared to the standard approach |
Alam, 2019 [27] | Machine-learning approach to train and evaluate a model for AI classification of retinopathies | The study demonstrated that use of the AI model was feasible. |
Al-Aswad, 2021 [28] | Mobile clinic with in-person evaluation; OCT and nonmydriatic fundus photography sent to an eye institute for analysis by ophthalmologist or optometrist in real time; videoconference conducted with patient to provide results | A small percent of patients screened positive for diabetic retinopathy and were referred for follow-up. Diabetic retinopathy was confirmed in most of those reached, and additional eye problems were detected in almost half. |
Daskivich, 2017 [29] | Fundus photographs taken and uploaded by trained primary care clinic staff; off-site optometrist read photos to determine diabetic retinopathy grade, follow-up recommendations, and feedback; electronic results sent to PCP | Increased annual screening rates and reduced wait-time. |
Hatef, 2017 [30] | Nonmydriatic fundoscopic camera to take retinal images at primary care visit, sent to an eye institute, evaluated, and returned to PCP. PCP recommended ophthalmologist follow-up for those with signs of diabetic retinopathy | Annual exam completion rate increased; a small percentage of those who had diabetic retinopathy identified in their scan and were referred to ophthalmologists completed the referral. |
Jani, 2017 [31] | Patient’s retinal images taken by trained staff at a primary care visit and sent to a retinal specialist for remote review; specialist classified the level of diabetic retinopathy, gave recommendations, and sent results to PCP within 24 h | Post-implementation screening rate increased over pre-implementation screening rate. Some patients screened with diabetic retinopathy received a referral; some did not. Of those referred, the majority completed their referral visit within study period. |
Liu, 2019 [32] | An existing teleophthalmology program that allows PCP to refer patients with walk-in scheduling | Patient barriers included unfamiliarity with teleophthalmology, misconceptions about screening, and logistical difficulties. Facilitators included PCP recommendation and convenience factors. PCP barriers included not knowing when screening was due and unfamiliarity with teleophthalmology. Facilitators included ease of referral process and communication of results. |
Mehranbod, 2019 [33] | An automated telephone reminder a week prior to primary care appointment for screening in addition to a telephone reminder by medical assistant within a week of appointment | Attendance rates for appointments were lower among African American patients compared with Latino patients. Adding automated reminders improved attendance and narrowed the disparity in rates between African American and Latino patients; rates for both groups remain low. |
Ramchandran, 2020 [34] | Patient care technician or nurse took digital photos of the eye; an ophthalmologist read images and uploaded disease and visual acuity results. Clinicians followed-up with patient based on reports in the EMR. | Patients rated teleophthalmology as highly as regular care, perceived high value of teleophthalmology, and were willing to pay an equivalent copay. |
Rowe, 2021 [35] | Medical students provide ophthalmology screening services to patients under the supervision of one ophthalmology attending physician and one resident ophthalmologist. | The clinic showed significant cost savings for each screening conducted. |
Serrano, 2018 [36] | Nurse took digital eye photos with dilation if deemed necessary; images uploaded to a website and reviewed by a fellowship-trained ophthalmologist at a university; patient returned for follow-up appointment with nurse to discuss results | Patients expressed satisfaction with telemedicine and preferred it to in-person visits; patients who had prior face-to-face exams were less likely to prefer telemedicine. |
Tan, 2021 [37] | OCT obtained by eye doctors in a mobile van and interpreted remotely by retinal specialists. | Among patients with diabetes, OCT and clinical exam had moderate agreement in diagnosing retinopathy. |
Author | Brief Intervention Description | Main Relevant Findings |
---|---|---|
Bagcivan, 2018 [38] | Early palliative care consultation (within 60 days of lung cancer diagnosis) | Early consultations addressed patient and family concerns not typically addressed in cancer care visits. Commonly evaluated symptoms were mood, general pain, and cognitive/mental status. |
Beer, 2020 [39] | Breathe Easier app with mindfulness-based cancer recovery content | Primary benefits were convenience and having credible health information; top concerns included cost and difficulty of use. |
Cardarelli, 2020 [40] | Application of Lung-RADS categories compared with retrospective LDCT results | Fewer additional tests using Lung-RADS compared with NLST. Among those with additional testing, the number identified with cancer was higher using Lung-RADS compared with NLST. |
Cykert, 2019, 2020 [41,42] | Multi-faceted quality improvement intervention including a real-time warning system with missed appointments and deviations from standard timelines, quarterly clinical performance reports with aggregated completion of cancer treatments by patient race, nurse navigator, physician champion, and staff training on health equity | 2019—Among patients in the intervention group, treatment completion rates did not differ between Black and White patients. Among patients in the control groups, Black patients had reduced treatment completion compared with White patients. 2020—Black and White patients in the intervention group had similar receipt of curative treatments. Black patients in the retrospective group had lower rates of receiving curative treatment compared with White patients. |
Erkmen, 2021 [43] | Community engagement in churches and other community settings providing pamphlets with education and alliances with community leaders in each setting; CME for participating providers on screening program; lung cancer screening performed; paper and EMR forms for referrals to screening; SDM using a decision aid; radiology report provided by chest radiologist; imaging with LDCT; smoking cessation with pharmacology aids; 2-year follow-up by telephone | At 1 year, all people with Lung-RADS categories 3 or 4 adhered to follow-up screening, but only 23.7% of those with negative screens adhered. At 2 years, only 35.4% with positive screens and no cancer followed up. |
Fung, 2018 [44] | A cancer prevention seminar providing Asian Americans with information about cancer prevalence and common cancers for Asian Americans, cancer risk factors and early warning signs of common cancers, cancer myths and facts, an overview of the American Cancer Society cancer screening guidelines, and actionable ways to reduce cancer risk. | Seminars developed for Cantonese-speaking Chinese Americans changed the beliefs and stated behaviors of Chinese Americans. Both groups had high knowledge at baseline. Changes in knowledge, attitudes, and screening intent were minimal between groups. |
Huang, 2021 [45] | A molecular tumor board provided recommendations to clinicians for specific therapy and clinical trials based on patient diagnosis and next-generation sequencing testing results. | Compared to those with reviews, those without reviews had poorer survival. |
Lau, 2021 [46] | A modified version of a web-based decision aid (shouldiscreen.com) with basic information about LDCT screening, education about lung cancer risk factors, and calculation of personalized lung cancer risk | Use of the decision aid led to small improvements in knowledge and increased concordance with current recommendations. |
Li, 2020 [47] | AHRQ decision-aid “Is Lung Cancer Screening Right for Me?” translated in Chinese and adapted to health literacy and cultural needs | Participants reported that the adapted decision aid would facilitate informed decision making for LDCT screening. Based on reviewing the decision aid, the majority of patients understood causes and symptoms of lung cancer and LDCT screening and associated benefits, harms, and insurance coverage, although the majority were unable to understand the content without help. |
Liu, 2020 [48] | State-level Medicaid expansion | Compared to men in states that did not expand Medicaid, those in states that did expand Medicaid had greater increases in 2-year survival and early-stage diagnosis. Outcomes for women did not differ among states that did and did not expand Medicaid. |
Loehrer, 2018 [49] | State-level Medicaid expansion | Rates of complex surgical care increased relative to non-expansion states. The probability of undergoing surgical resection at high-volume hospitals did not change. |
Olazagasti, 2021 [50] | NCCN screening criteria | Among patients already diagnosed with lung cancer, significantly more Hispanic/Latinx patients did not qualify for screening based on USPSTF guidelines compared with patients of other races. Rates of eligibility did not differ between African Americans and those who were White, Asian, or other races comparing the NCCN or USPSTF guidelines. |
Otto, 2021 [51] | Presence of a companion at a patient care encounter with a medical oncologist | When a companion was present, oncologists provided more patient-centered communication and spent more time with patients. Oncologists perceived patients to be more active participants and to have more social support. |
Owens, 2020 [52] | Breathe Easier app with content for mindfulness-based cancer recovery | The majority of participants thought the app was appropriate for African Americans, the information was well-understood, and that it would benefit lung cancer survivors to use the app. Participants were receptive to using the app but raised concerns of health literacy for others. |
Pasquinelli, 2020 [53] | PLCOm2012 criteria | Among African American patients, the PLCO model had higher sensitivity for lung cancer screening compared with the UPSTSF guidelines. |
Percac-Lima, 2018 [54] | Patient navigator support including brief smoking cessation counselling, reminding patients of CT screening, helping with translations, insurance issues, transportation concerns, other system barriers, and follow-up with patients about results from shared decision-making appointments with a primary care provider | The proportion of patients receiving CT screening via chest or lung CT was higher among those receiving the patient navigator compared with those receiving usual care. |
Prosper, 2021 [55] | Use of LDCT to screen for lung cancer among at risk individuals | Among a synthesized sample of Black individuals, LDCT screening had a greater relative reduction in lung cancer mortality. |
Raghavan, 2020 [56] | Mobile screening unit using a 35-foot coach with waiting area, portable LDCT scanner, high-speed wireless internet, and portable electronic tablet with smoking cessation education. Electronic images were sent for central review to an expert panel. | Screening identified 601 pulmonary nodules, including 267 participants with Lung-RADS 1, 183 participants with Lung-RADS 2, 62 participants with Lung-RADS 3, and 38 participants with Lung-RADS 4 lesions. Among those screened, 12 had lung cancer. |
Randhawa, 2018 [57] | Free community LDCT screening program; tumor board review of Lung-RADS 3 or 4 findings and results sent to ordering physician by mail or via electronic records. Phone call to patients with results, and certified mail if needed | Screening identified 18.3%, 68.6%, 9.5%, and 3.6% of participants as Lung-RADS 1, 2, 3, and 4, respectively. Among physicians surveyed, 15% had never referred a patient. Barriers to referral included time constraints and precertification requirements. |
Sender, 2019 [58] | Paper reminder placed in the chart for the provider to prompt screening prior to visit and providers received update when patients missed screenings. | After 6 months, screening rates improved compared with prior to the intervention. |
Sferra, 2021 [59] | Option Grids brief information sheet to guide physician–patient encounters to discuss lung cancer screening options. | Patients randomized to Option Grids had lower decision regret and higher knowledge regarding next steps for positive screens and potential need for invasive procedures.. |
Springer, 2018 [60] | Campaign to increase lung cancer screening in rural Michigan using GoogleAds, gas station and convenience store flyers, and radio public service announcements. | Evidence did not show differences in screening rates between patients with more than and less than a 30-year smoking history. |
Thurlapati, 2021 [61] | 2018 NCCN Lung Cancer Screening Guidelines revised using an individualized risk-based Tammemagi Calculator to determine who should be screened for lung cancer | One-third of patients diagnosed with lung cancer did not meet the 2103 screening guidelines. Using the revised NCCN guidelines, 12.5% who were ineligible for screening would have been qualified for LDCT; however, 87.5% of those patients with lung cancer who were missed would still not have met screening criteria. Among those who did not meet screening guidelines, 50% were African American. |
Townsend, 2021 [62] | LDCT screening program in a rural hospital setting following referral patterns in the 2013 USPSTF guidelines | Lung cancer was detected in 1.4% of screens over 8 years. |
Williams, Looney, 2021 [63] | Four 90 min sessions provided by trained CHWs to educate community members about lung cancer screening and attitudes towards lung cancer. | Knowledge, perceived benefits of lung cancer screening, and self-efficacy increased and perceived barriers decreased among participants. |
Williams, Shelton 2021 [64] | Trained CHW delivered a 90 min session with educational content including an overview of cancer screenings and risk, severity, benefits, and barriers to lung cancer screening and prevention. | The intervention helped reach more patients and educated them about cancer screenings. Participants improved on some, but not all, knowledge, benefit, and stigma measures. |
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Mossburg, S.; Kilany, M.; Jinnett, K.; Nguyen, C.; Soles, E.; Wood-Palmer, D.; Aly, M. A Rapid Review of Interventions to Improve Care for People Who Are Medically Underserved with Multiple Sclerosis, Diabetic Retinopathy, and Lung Cancer. Int. J. Environ. Res. Public Health 2024, 21, 529. https://doi.org/10.3390/ijerph21050529
Mossburg S, Kilany M, Jinnett K, Nguyen C, Soles E, Wood-Palmer D, Aly M. A Rapid Review of Interventions to Improve Care for People Who Are Medically Underserved with Multiple Sclerosis, Diabetic Retinopathy, and Lung Cancer. International Journal of Environmental Research and Public Health. 2024; 21(5):529. https://doi.org/10.3390/ijerph21050529
Chicago/Turabian StyleMossburg, Sarah, Mona Kilany, Kimberly Jinnett, Charlene Nguyen, Elena Soles, Drew Wood-Palmer, and Marwa Aly. 2024. "A Rapid Review of Interventions to Improve Care for People Who Are Medically Underserved with Multiple Sclerosis, Diabetic Retinopathy, and Lung Cancer" International Journal of Environmental Research and Public Health 21, no. 5: 529. https://doi.org/10.3390/ijerph21050529
APA StyleMossburg, S., Kilany, M., Jinnett, K., Nguyen, C., Soles, E., Wood-Palmer, D., & Aly, M. (2024). A Rapid Review of Interventions to Improve Care for People Who Are Medically Underserved with Multiple Sclerosis, Diabetic Retinopathy, and Lung Cancer. International Journal of Environmental Research and Public Health, 21(5), 529. https://doi.org/10.3390/ijerph21050529