Preventative Screening Use among Medically Underserved Patients from Central Appalachia

Purpose: Previous research has demonstrated the potential for preventative health services to help address the existing health disparities in Central Appalachia. The Remote Area Medical Corps (RAM) Clinic in Wise County, Virginia provides a critical opportunity to understand preventative screening rates and factors affecting use for medically underserved patients in the region. This thesis contributes to existing regional research by being the first to survey a large, regional sample of underserved patients. Methods: Over the course of three days, 205 patients were surveyed using questions primarily taken from two national health surveys. Patient characteristics and screening rates were compared to national data from the US Census and previous analysis of national health surveys. In addition, multi-variable model selection was used to identify the best predictors of screening use for RAM patients. Results: RAM patients overwhelmingly have low rates of preventative screening use according to the United States Preventative Screening Task Force Guidelines. On average, patients were missing at least a third of the recommended screenings. Colon, breast and cervical cancer screening rates fall well below the national averages. Blood pressure, blood cholesterol and lung cancer screening use is low. Model selection results show the importance of a healthcare visit within the past year, access to a personal provider and a routine checkup. Conclusions: Low screening rates combined with the existing mortality disparities and established benefits of early screening demonstrate the need and potential of health care reform to improve regional preventative services use.