A5 Using Public Health & Afrocentric Approaches_Onye Nnorom

Using Public Health & Afrocentric Approaches for Increasing Cancer Screening in Primary Care O. Nnorom, MD L. Gebremikael, E.D. TAIBU N. Shi, PA

CFPC Conflict of Interest

Disclosure of Commercial Support Presenter Disclosure Presenters:

Onye Nnorom, Liben Gebremikael, Nan Shi

Relationships with commercial interests: • • • •

Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None

Context: Health disparities & Vulnerable communities 





Interventions based on broad population-based (i.e. Geoffrey Rose) approaches … “may have led to unintended exacerbations of health disparities.”

TAIBU CHC is an example of an organization that uses a vulnerable communities approach to address health disparities.

“A focus on vulnerable populations is complementary to a population approach and necessary for addressing social inequalities in health”

Frohlich KL1, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008 Feb;98(2):216-21.2007.

Overview  Background

– TAIBU  Cancer screening Taskforce 

phase 1 (2013) – internally-focused  Methods

(PDSA, Afrocentric values)  Results (MSAA Indicators) 

Phase 2 (2014+) – community-focused

 Think

Tank – promising practices

TAIBU VALUES 

WE BELIEVE: Equity is essential to the achievement of a healthy community Quality service is integral to our community Cultural competence is a key component in how the organization functions The community’s success lies in within its inherent strengths and assets



WE RECOGNIZE: The prevalence of Anti-black Racism and its impact on the way the community accesses and receives services

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WE ARE COMMITTED TO: Cultivating an environment free of discrimination of any type

• • • •

•

•

Clinical Programs 

PRIMARY HEALTHCARE: o Hypertension Management Program in partnership with the Heart & Stroke Foundation o Sexual Health Clinic in partnership with Toronto Public Health o Diabetes Education Program o

Specialized Primary Care services for Adults with Sickle Cell Disease

o o o

Chiropody Social Work Nutrition Support

Health Promotion Stand up for Health – innovative program targeted at youth to learn about the social determinants of health in a fun and experiential environment.

• Elders Program – UBUNTU • L.E.A.R.N. afterschool program • Physical activity programs

TAIBU - Cancer Screening 

Cancer Screening rates (Dec 31, 2012): • • •



PAP offered: 53% FOBT offered: 22% Mammography offered: 21%

Cancer Prevention Taskforce • • • • •

Deva Nicholas, MD Nan Shi, PA Nancy Akor, RN Patricia Wright, NP Onye Nnorom, MD (Lead)

Engage staff using PDSA & Afrocentric model of care 

Plan, Do, Study, Act   

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Iterative process Continuous Quality Improvement Learn as we go!

Afrocentric values approach:   

Focus on the collective/community Need to identify those who got screened so we can find those who didn’t, and save lives!

Not about indicators, LHIN/MOHLTC, or bonuses (FHTs, not CHCs!)

Assessment – data & literature  Review  

Ask staff if TAIBU indicators valid Assess vulnerability (Black pop-cancer risk)

 Quick 

data

Literature Review

Identify barriers, solutions

Cancer

Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,

2005

From: CDC, OHMD. Black or African American Populations. Slides. http://www.cdc.gov/omhd/Populations/BAA/BAA.htm#Disparities Original Source: CDC, OMHD, 2007 report. http://www.cdc.gov/omhd/Populations/BAA/BAA.htm

Colon, Rectum & Anus Cancer

Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,

2005

From: CDC, OHMD. Black or African American Populations. Slides. http://www.cdc.gov/omhd/Populations/BAA/BAA.htm#Disparities Original Source: CDC, OMHD, 2007 report. http://www.cdc.gov/omhd/Populations/BAA/BAA.htm

Breast Cancer

Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,

2005

From: CDC, OHMD. Black or African American Populations. Slides. http://www.cdc.gov/omhd/Populations/BAA/BAA.htm#Disparities Original Source: CDC, OMHD, 2007 report. http://www.cdc.gov/omhd/Populations/BAA/BAA.htm

Prostate Cancer

Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,

2005

From: CDC, OHMD. Black or African American Populations. Slides. http://www.cdc.gov/omhd/Populations/BAA/BAA.htm#Disparities Original Source: CDC, OMHD, 2007 report. http://www.cdc.gov/omhd/Populations/BAA/BAA.htm

Situation: Health disparities & vulnerable communities ď‚› Under-screened

population/communities (SES, education, culture, marginalization)

ď‚› Potentially

at increased risk (race/genetics)

Planning • •



Goal/Objectives:

Increase the Cancer Screening rates at TAIBU, and beyond • Obtain accurate data, target under-screened clients • Reduce barriers to screening • Educate and empower the community

Evidence-Informed Activities (lit review & exp) 



Barriers: health education, beliefs, other health conditions, gender of provider/tech, provider time constraints

Promising practices: culturally-relevant educational sessions, videos, facilitating transportation, provider reminders, audits

Doing – Provider Education  

Provider Guideline Review package Instructions on how to enter cancer screening data into EMR (Purkinje/NOD)

 TAIBU staff education session • Dr. Onye Nnorom: Overview • Dr. Sheila Mae Young, CCO Primary Care Lead for CE-LHIN: Guidelines Review • Ms. Aggie Mazzucco: Barriers & Promising practices to screening in immigrant populations

Doing – Audits  Cancer •

•

Screening Audit

Review of clients overdue for screening in EMR Corrected if tests in chart indicated they had colon, breast, cervical CA screening recently or did not qualify

TAIBU Cancer Screening Audit (2013) 

Total charts reviewed: 603   



Patient need FOBT test: 244 Patient need Mammography: 135 Patient need Pap smear test: 224

Purkinje 

Where to find the information: Reports  Previous record  CPX 

TAIBU Cancer Screening Audit (2013)  Data

correction (tests that were done but were not entered into EMR):   

Pap Smear done within 3 years: 24 FOBT done within 2 years: 64 Mammography done within 2 years: 48

Doing – Addressing client barriers  Identification

of nearest OBSP site (female technicians) – 1333 Neilson= less travel

 Call-back   

program (pilot)

Provider audit of patients overdue for screening Front-desk: calls - Nancy (RN) & Nan (PA) performed pap, ordered FOBT, mammogram Medical directives, training, checklists

Study – the Results – MSAA Indicators Test Offered

Ending Dec 2012

Ending July 2013

Ending Dec 2013

FOBT (colon)

22%

39.9%

43%

Pap (cervical)

53%

53.1%

48%

46.8%

46%

Mammogram 21% (breast)

We also obtained informal feedback about the callback program

Act - Phase 2 – Optimization & Community engagement     

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Improved Call-back program (longer duration, NOT during Ramadan) Basic info for clients - Pamphlets, signs KTE (town halls, community education) Repeat data correction (2013-2014) due to EMR change Start tracking actual outcomes (% test completed, diagnosed, treated, connected with culturallyappropriate support groups) Considering: letters, staff reminders

[Future PH-relevant research]  Population

health assessment (TAIBU clients at time of intake, DoH) for program planning  Flu vaccine – exploring reasons for declining vaccination  KTE – topic area: Black women - breast and cervical cancer risk & screening awareness

THANK YOU!!!  TAIBU

Community Health Centre  Cancer Screening Taskforce  CCO  AOHC & ALPHA

Group Discussion: Promising Practices  Examples/ways

that PHUs/PH practitioners can work with CHC’s to:  



Increase cancer screening in underscreened/vulnerable communities Improve chronic disease prevention in vulnerable communities (diabetes, CVD, etc.)

Positively impact social determinants of health in vulnerable communities