Preventive screening utilization in nurses and in the general population: a Taiwan study
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Purpose: The growing incidence of cancer in middle-aged and elderly populations has increased the importance of preventive measures such as cancer screening programs. In 1996, the National Health Insurance Bureau in Taiwan launched a breast cancer screening program that included breast examinations by physicians, mammograms, educational programs for breast cancer self-examination, and Pap smear tests. This study focuses on the utilization of the two main breast cancer screening measures: breast examination (including breast examination by physicians, by mammograms, and by self-examination) and Pap smear testing. Ten-year trends in utilization of breast cancer screening programs by female nurses and medical personnel were compared with those in females in the general population. Methods: Reimbursement data for all outpatients and inpatients diagnosed with major occupational cancers during 1997-2010 were collected from the National Health Insurance Research Database (NHIRD). For the secondary data analysis, 2002-2010 data for reimbursement claims from the Taiwan Bureau of National Health Insurance for breast cancer screening services were collected from the NHIRD. A conceptual framework based on the “behavioral model of utilization” was used to analyze the breast cancer screening service utilization from the perspectives of nurses. Results: Objective 1 The triennial coverage rate of Pap smear for 30-60 years old women in 2004 was 50.00% in non-medical personal group, 39.09% in physician, 49.88% in pharmaceutist, and 47.36% in nursing staff. Until 2010, the triennial coverage rate was 52.69% in non-medical personal group, 40.61% in physician, 49.35% in pharmaceutist, and 53.29%. Additionally, the Pap smear was significantly increasing in Nurse but not in Physician and Pharmaceutist group. The Biennial year coverage rate of mammography screening are as follow: year 2003 general population 5.51%, physicians 7.41%, pharmacist 12.68%, nurse 13.43%, in year 2010 respectively are 24.94%、25.6%、25.18% and 34.4%, The mammography screening rates were increasing significantly except for pharmaceutics group. Objective 2 The RR of first visit of cervical carcinoma in situ with Triennial utilization of Pap smear screening are greater than cervical cancer, the RR of cervical carcinoma in situ was 28.87 (95% C.I.= 21.45-38.85) and RR of cervical cancer was 7.39 (95% C.I.=6.03-9.05) in all participations . But the RR of first visit of breast cancer with biennial mammographic screening was higher than benign breast tumor or Benign breast tumor, the RR of breast cancer was 25.06(95% C.I.= 22.01-28.54) and RR of benign breast tumor was 16.72(95% C.I.=15.82-17.67) in all participations . Objective 3 I found that in nurses, Pap smear screening was most common in that younger age, and those in high income groups. In contrast, mammography was most common in nurses being older, and with a high education level. In addition, nurses with working experience in primary healthcare setting were more likely to utilize mammography. Conclusion: This study provides data that health care providers and public health policy makers in Taiwan can use to increase utilization of breast cancer screening services by nurses , including Pap smear screening and mammography. Improved understanding of the health risks of cervical and breast cancer would also encourage women to undergo Pap smear screening and mammography by increasing their awareness of the importance of early detection and prevention. The factors that affect utilization of cancer screening programs by nurses must be clarified not only to guide health policy decision making, but also to provide an evidentiary basis for designing health promotion and disease prevention interventions in individual clients.