Testing for Disease
|“To eliminate the gap in testing, we made five grants totaling $1.65
million to the Fund for Public Health beginning in 2003. The project
successfully employed patient navigators to reach out to blacks and
Latinos and help them get colonoscopies.” - Len McNally, Trust Program Director|
Protecting New Yorkers from Colon Cancer and STDs
People live longer, healthier lives—and incur lower health care costs—when disease is diagnosed and treated in its early stages. Unfortunately, Chlamydia and the early stages of colon cancer rarely have symptoms and many New Yorkers weren’t getting diagnosed until the diseases advanced. The alarming rates of sexually transmitted diseases among the City’s youth, along with the number of preventable deaths from colorectal cancer, especially in black and Latino communities indicated precisely where more testing was needed. In order to help reach those most at risk, The Trust funded two pilot projects. The first was a Chlamydia education and testing program in high schools, the second a patient navigator program to help black and Latino New Yorkers over the age of 50 or with a family history of colon cancer get colonoscopies. Both were very successful in catalyzing public funding for these screening and prevention programs.
More Testing in City Schools?
Much to high school students’ relief, the tests don’t involve #2 pencils or multiple choice bubbles. Common and easily spread in adolescents and teens, Chlamydia is a serious infection that if left untreated can cause infertility and pelvic inflammatory disease. But it is also easily detected through a simple urine test, and cured easily with antibiotics—but only if the infections are caught early enough. Because these infections are asymptomatic, kids weren’t being tested, despite the fact that adolescents in general and young women in particular are most likely to catch them.
In order to make STD testing in high schools a reality, the City Department of Education and the Department of Health and Mental Hygiene’s Bureaus of School Health and STD Control needed to see if it would work. With an $85,000 grant to the Fund for Public Health of New York in 2005, the program was run in five high schools. Education and voluntary Chlamydia and gonorrhea testing was offered, and treatment was given to those who needed it. Meighan Rogers of the City’s Bureau of STD Control says that “the City wanted to see a successful program, one that would involve parents from the outset, educate teens, and identify and treat sexually transmitted infections. With the pilot program, we were able to prove success in these areas.”
Based on this success, the City committed approximately $900,000 annually through 2011 for the continuation of the program, which is now in 125 schools and tested more than 11,000 students for Chlamydia and gonorrhea in 2008. “Parents receive a letter about the program, and can opt to not have their children participate,” said Ms. Rogers. “We have also been doing presentations at parent association meetings, but parents have been very open to it; we get about 15 to 20 opt-outs each year.”
At some schools, teens have been tested annually and have come to expect the service. The City’s STD clinics have also seen double the number of teens come through their doors, indicating that the program is getting teens to be more responsible about their reproductive and sexual health.
Taking the Fear Out of Colonoscopies
Colon cancer is scary, but the prospect of getting screened makes most of us squirm. Throw in a clear liquid diet the day before and a gallon of laxative punch and you’ve got a pretty tough sell, especially to people with no symptoms. But a colonoscopy can be a life saver, detecting pre-cancerous polyps that can easily be removed before they develop into cancer.
|Trust Pilot Programs Result in Expansion of City Screening Programs, 2003 - 2008|
“All men and women over the age of 50 should have this procedure done, but six years ago, too few blacks and Latinos in the City were getting tested,” says Len McNally, program director at The Trust. “To eliminate the gap in testing, we made five grants totaling $1.65 million to the Fund for Public Health beginning in 2003. The project successfully employed patient navigators to reach out to blacks and Latinos and help them get colonoscopies.” Now expanded from 1 to 16 sites, the program contributed to nearly half a million New Yorkers getting tested for colon cancer every year, an eighty-fold increase from 2003.
Little understanding and a lot of fear about the process inhibits many people from scheduling and showing up for their tests. But navigators, such as Rosemilly Ellakkis and her co-navigator Peter Correa at Jacobi Medical Center in the Bronx, hold patients’ hands and help dispel misconceptions. Ellakkis continued, “many patients are afraid of starving, but you can actually drink broth and clear juices and eat popsicles. We also let them know that they will be given a sedative and will be comfortable during the procedure.” The quality of care is spreading by word of mouth, and patients refer their spouses, cousins, and siblings to Jacobi, and are told to “ask for Rosemilly.”
Navigators start helping the patients as soon as a doctor suggests they get tested. “Connecting with patients over the phone and in person is the most important thing we do, though that’s not always easy,” continues Ms. Ellakkis. “Oftentimes low-income people and immigrants move frequently or use prepaid cell phones, so they can be very difficult to track down. But we do the leg work, and it pays off—after a half hour of answering all of their questions over the phone, patients are much more likely to prepare for the procedure correctly, feel more comfortable, and most importantly, show up on the day of the test.” Fewer no-shows mean a significant cost savings for hospitals. A Trust-funded study by the Department of Health found that the navigator program pays for itself, and even generates modest revenue. This increases the likelihood that even in times of budget cuts, this program is more likely to survive.