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Role of patient race/ethnicity, insurance and age on Pap smear compliance across ten community health centers in Florida
Community Health Centers (CHCs) are the nation's primary care safety net for vulnerable populations, including racial/ethnic minorities, immigrants, migrant workers, and those who are uninsured. Women from such population sub-groups contribute disproportionately to cervical cancer incidence, morbidity, and mortality due, in large part, to the underutilization of Papanicolau (Pap) smear screening. Routine Pap smear screening can detect the onset and prevent progression of cervical malignancies. This article reports findings of a cross-sectional study to investigate the association between Pap smear compliance and patient race/ethnicity, insurance, and age for more than 60,000 women seen in a network of CHCs in Florida. Results of this study indicated a strong association between race/ ethnicity and Pap smear screening in CHCs. Among women aged 21-45 years, Hispanics were twice as likely to receive Pap smear screening, while Blacks were 1.45 times more likely to receive Pap smear screening, when compared to White women. These results were unexpected because most studies have shown that Hispanic women are less likely to receive screening than their Black and White counterparts. These findings highlight the need to further explore the contribution of race/ethnicity, insurance, age, and other risks on health disparities associated with cervical cancer screening in CHCs. Moreover, results from this study have subsequently led to the development of clinical data reporting software to support Pap smear compliance monitoring within CHCs, as well as best practices regarding standardized documentation of Pap smear within electronic health records
Identifying opportunities in EHR to improve the quality of antibiotic allergy data.
BACKGROUND: Antimicrobial resistance is a growing, global public health crisis, due in large part to the overuse and misuse of antibiotics. Understanding medication allergy data and allergy reactions that are documented in electronic health records (EHRs) can help to identify opportunities to improve the quality of documentation of beta-lactam allergies, thus potentially reducing the prescribing of alternative antibiotics.
METHODS: Medication allergies and allergy reactions recorded in the EHR for 319 051 patients seen across 32 community health centers were reviewed. Patients with a beta-lactam allergy recorded in their EHR were identified. Free text, as well as standardized allergy and allergy reaction fields, were analyzed.
RESULTS: Among patients, 9.1% (n = 29 095) had evidence of a beta-lactam allergy recorded in their EHR. Women, white, and non-Hispanic patients were more likely to have a documented allergy compared to men, black, and Hispanic patients. Among all patients with a documented beta-lactam allergy, 36.2% had an empty or missing allergy reaction description in their EHR.
CONCLUSIONS: Findings suggest that current EHR documentation practices among the health centers reviewed do not provide enough information on allergic reactions to allow providers to discern between true allergies and common, but anticipated, drug side effects. Improved EHR documentation guidance, training that reinforces the use of standardized data and more detailed recording of allergic reactions, combined with initiatives to address patient barriers including health literacy, may help to improve the accuracy of drug allergies in patients\u27 records. These initiatives, combined with antimicrobial stewardship programs, can help to reduce inappropriate prescribing of alternative antibiotics when beta-lactam antibiotics are first-line and can be tolerated