Racial gap leads clinics to add same-day preventive care

Taji Bonsamo didn't set out to get a mammogram last week. She just felt like she had a bad cold and went to see the doctor.

But once she was at HealthPartners' Riverside Clinic in Minneapolis, the staff noticed that she was overdue for a breast-cancer exam. If she could stay a little longer, she was told, they could do it that day.

Bonsamo, who had never had a mammogram before, said yes.

"Instead of traveling twice, it's a good thing," Bonsamo, an Ethiopian immigrant in her 60s, said through an interpreter. Because she doesn't drive, she has to rely on relatives for transportation. "That's why I decided to take it now."

Last fall, HealthPartners began experimenting with same-day mammograms as a way to encourage more minority patients to get the checkups. The idea was so successful, officials say, that they're now offering same-day options at all six HealthPartner clinics with mammography machines.

The idea was inspired by a study, which HealthPartners is releasing today, that found that blacks and other racial minorities are less likely than whites to get certain types of preventive care, such as cancer screening, at its clinics.

"Even though you might offer it to everyone the same," said Dr. Beth Averbeck, an associate medical director at HealthPartners, "it isn't necessarily the same as a patient having it done."

• Breast cancer screening: 21 percent of minority women in the recommended age groups were overdue for mammograms, compared with 12 percent of white patients.

• Colon cancer screening: 49 percent of minority patients were overdue for colonoscopies, compared with 39 percent of white patients.

• Diabetes care: 17 percent of minority patients had "optimal diabetes care," compared with 24 percent of white patients. Optimal means that their blood sugar, cholesterol and blood pressure levels are under control, they don't smoke and they take aspirin.

The findings weren't a total surprise. "We knew that nationally there are disparities," said Averbeck, who is heading the HealthPartners initiative. But this was the first time that the organization examined the problem in its own hospital and clinics.

"(When) you know that it's my patients that may not be receiving equitable care, it's a whole different emotional response," said Averbeck, a specialist in internal medicine.

Members of a HealthPartners task force started asking what the clinics could do to make it easier for patients. "That's where the idea of the same-day mammogram came [up]," said Averbeck.

Last fall, it started pilot projects at two clinics, offering the option to any woman who was overdue for a mammogram and came into the clinic for any reason.

About half said yes, Averbeck said. The clinics found there was usually room to squeeze them in along with the women already scheduled, she said.

"I think it's made a big difference," said Marybeth Causse, manager of the Riverside clinic.

Averbeck said she thinks most women will still prefer to schedule in advance, to avoid long waits. But she called it a "safety net" for those who might otherwise miss out.

The Riverside clinic, meanwhile, also offers routine checkups to entire families at once. If a parent brings in a sick child with several siblings in tow, "we ask if we can see them, too," said Causse. That saves the family time and inconvenience and helps make sure the kids are up to date on their vaccines.

Willie Mae Wilson, a HealthPartners board member and former president of the St. Paul Urban League, said the effort is paying off. We're "going the extra mile, so to speak, to encourage people to come in," she said. "I think we are getting people's attention. We are helping them understand this whole concept of preventive care."