J. Tinglin1, M. Tipre2, A. B. Crouse3, K. D. Martin4, L. Gutnik5, H. Krontiras6 1University Of Alabama at Birmingham, Medicine, Birmingham, Alabama, USA 2University of Alabama Heersink School of Medicine, UAB Division of Preventive Medicine, Birmingham, Alabama, USA 3University Of Alabama at Birmingham, Precision Medicine Institute, Birmingham, Alabama, USA 4University of Alabama at Birmingham School of Public Health, Department of Epidemiology, Birmingham, Alabama, USA 56University Of Alabama at Birmingham, Surgery, Birmingham, Alabama, USA
Introduction: Secondary prevention can serve to maintain patients’ long term health and avoid the costs of chronic disease. At the Preventive Care Program for Women’s Cancer Clinic at UAB (UABPC), multidisciplinary staff provide women at increased risk for breast cancer specialized preventive care via a comprehensive risk assessment with resultant recommendations for screening and management strategies. In 2011, several provisions of the Affordable Care Act (ACA) eliminated cost sharing of basic women’s preventive screening programs for patients with non-grandfathered health insurance plans. This increased affordability and accessibility of care for millions of Americans and increased awareness of racial disparities in preventive care. In this study, we examined the potential influence of these provisions on increasing total and minority patient participation in specialized preventive services in the UABPC.
Methods: Patients seen in this clinic were consented and data was collected to understand use of preventative services. 2003-2011 was designated as the pre-ACA enactment period and 2011-2019 as the post-ACA enactment period. We further subdivided patients’ enrollment dates in the clinic into 4-year periods to more closely assess trends in total and minority patient participation as a function of ACA implementation. Patients’ age, race, first clinic date, and socioeconomic status (SES) were considered for their impact on uptake of services pre and post-ACA.
Results:Between 2003-2019, 2,786 patients were entered into this database. From 2003-2011, minority patients comprised 6.4% of clinic patients and between 2011-2019 minority clinic patients nearly tripled to comprise 18.6% of all patients seen. We conducted an overall Chi- Square analysis of patients seen in this clinic by race pre- and post-ACA, demonstrating a significant increase in total and minority patients with a p value<.0001. An overall Chi-Square analysis of patients by race among the aforementioned 4 year time-periods also demonstrated a significant increase in patients between 2007-2011 and 2011-2015 with a p value<.0001.
Conclusion:We demonstrate a change in uptake of our clinic’s preventive services and specifically changes to the racial makeup of the patient population following ACA implementation. The resultant reduced cost sharing for women’s preventive screening and federal advancement of the Offices of Minority Health are plausible factors in the statistically significant increase in preventive service usage and in total and minority patient enrollment within the UABPC. These results underscore the value of federal programs that decrease racial disparities in healthcare and increase access to preventive care for women at an increased breast cancer risk.
