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Women’s Health Week at Vanderbilt – Day 3, Tennessee Women’s Health

October 29, 2009

Yesterday I was able to attend another presentation as part of Vanderbilt’s Women’s Health Week, featuring Dr. Valerie Montgomery Rice and Dr. Gloria Richard-David of Meharry Medical College and Dr. Katherine Harmann of Vanderbilt who conducted a panel discussion on the state of women’s health in Tennessee. They centered the discussion around their collaborative work on the 2009 Tennessee Women’s Health Report Card, which I’ve posted about previously. Briefly, the report characterizes the health status of women in the state on measures such as cause of death, STIs, and reproductive health, comparing 2002 and 2007 data and grading our status for improvement/worsening and comparison to Healthy People 2010 goals.

When asked about what might have surprised them when working with the data for the report, Dr. Hartmann reported that unfortunately Tennessee women’s health status was as generally bad as they might have expected, which while not surprising is certainly not a positive situation. There was also discussion of how screening rates – such as for mammography- are pretty high, and yet rates for breast cancer deaths aren’t as good.

This led into a discussion of “going beyond access,” or figuring out to improve care and quality beyond those initial screening exams. The panelists talked about making sure appropriate follow-up care happens, of making sure people are treated in equal and appropriate ways, and examining why – if we achieve equal access to screening and follow-up care – outcomes might be different from individual to individual.

A piece in the New England Journal of Medicine on this topic, “Denial,” was referenced. Rather than being about denial of care or coverage, the article presents the case of a patient who fell through the cracks, who did not receive appropriate and needed breast cancer treatment simply because she did not receive a follow-up call and assumed the doctors were done with her care. It explains:

This patient’s journey began unremarkably: she presented promptly, complied with her workup, underwent grueling chemotherapy, and attended every scheduled appointment. Then, the theoretically seamless transition between the medical oncologist and the breast surgeon failed. When the patient’s call to the outpatient department was not returned, she took the silence and past encouraging assessments as signals that she was out of danger. To her thinking, no news was good news — not an uncommon belief among chronically ill patients who long for normality. The diligent breast care nurses inexplicably lost track of her. Her primary care physician assumed that her follow-up was taking place at the hospital and did not worry about not having seen her. Over the next several months, the patient continued to feel well and work full-time. She had little family, and her workmates probably thought it inappropriate to ask an apparently fit colleague about her illness. Thus, multiple individually plausible assumptions collectively compromised this patient’s outcome.

In that case, then, it wasn’t a problem of getting the patient in the door and access to screening – it was a problem of losing the patient in the often complex follow-up process.

There was also discussion of our very high infant mortality rate, the racial disparities in that rate, and the associated challenge of reducing preterm birth. The panelists indicated that enrolling women in early prenatal care has not made a dramatic difference in those preterm birth rates, and it’s a tremendous research challenge to figure out what else is going on and how those rates can be affected. The high rate of STIs was also discussed, with commentary that many have reacted that the rates are appalling, but that there is no reason to be appalled, there is simply reason to do better with sex education and prevention.

Thanks to the organizers for another great session! Check out their blog at http://vanderbiltwhw.blogspot.com/.

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