Costs and cost-effectiveness of a church-based intervention to promote mammography screening.

OBJECTIVES: To evaluate the costs of implementing a church-based, telephone-counseling program for increasing mammography use, and to identify the components of costs and the likely cost-effectiveness in hypothetical communities with varying characteristics. DATA SOURCES/STUDY SETTING: An ethnically and socioeconomically diverse sample of 1,443 women recruited from 45 churches participating in the Los Angeles Mammography Promotion (LAMP) program were followed from 1995 to 1997. STUDY DESIGN: Churches were stratified into blocks and randomized into three intervention arms-telephone counseling, mail counseling, and control. We surveyed participants before and after the intervention to collect data on mammography use and demographic characteristics. DATA COLLECTION/EXTRACTION METHODS: We used call records, activity reports, and interviews to collect data on the time and materials needed to organize and carry out the intervention. We constructed a standard model of costs and cost-effectiveness based on these data and the Year One results of the LAMP program. PRINCIPAL FINDINGS: The cost in materials and overhead to the church site was $10.89 per participant and $188 per additional screening. However, when the estimated cost for church volunteers' time was included, the cost of the intervention increased substantially. CONCLUSIONS: A church-based program to promote the use of mammography would be feasible for many churches with the use of volunteer labor and resources.

Community effects on access to behavioral health care.

OBJECTIVE: To explore the effects of community-level factors on access to any behavioral health care and specialty behavioral health care. DATA: Healthcare for Communities household survey data, merged to supplemental data from the 1990 Census Area Resource File, 1995 U.S. Census Bureau Small Area Estimates, and 1994 HMO enrollment data. STUDY DESIGN: We use a random intercept model to estimate the influences of community-level factors on access to any outpatient care, any behavioral health care conditional on having received outpatient care, and any specialty behavioral health care conditional on having received behavioral health care. DATA COLLECTION: HCC data were collected in 1997 from about 10,000 households nationwide but clustered in 60 sites. PRINCIPAL FINDINGS: Individuals in areas with greater HMO presence have better overall access to care, which in turn affects access to behavioral health care; individuals in poorer communities have less access to specialty care compared to individuals in wealthier communities. CONCLUSIONS: Our findings of lower access to specialty care among those in poor communities raises concerns about the appropriateness and quality of the behavioral health care they are receiving. More generally, the findings suggest the importance of considering the current status and expected evolution of HMO penetration and the income level in a community when devising health care policy.