Elsevier

Preventive Medicine

Volume 26, Issue 6, November 1997, Pages 791-800
Preventive Medicine

Regular Article
Enhancing Mammography Referral in Primary Care

https://doi.org/10.1006/pmed.1997.0219Get rights and content

Abstract

Background.This 1-year randomized trial tested the efficacy of behavioral techniques for increasing mammography referrals by primary care physicians in small, community practices.

Methods.Sixty-one practices were randomly assigned to one of three conditions: (1) education-only control, (2) education plus cue enhancement using mammography chart stickers, and (3) education plus cue enhancement plus feedback and token rewards. Quarterly chart audits of a defined sample (N= 11,716) of women patients 50 years of age or older were conducted to document mammography referrals, completions, and compliance.

Results.Referral and completion rates increased from baseline to first quarter and gradually declined thereafter. Overall, these rates were higher in the cuing conditions than in the control condition. In contrast, compliance rates in both experimental conditions increased over the year while remaining static in the control condition, demonstrating a strong and continuing effect for cue enhancement. Compliance increases were greatest for physicians who were older, nonwhite, with a second speciality, in solo practice, not members of the AMA, not residency trained, and not board certified.

Conclusions.Chart stickers can significantly increase mammography utilization in small, community practices. These practices are an efficient route to reaching large numbers of older women in need of mammography screening.

References (17)

  • KE Grady et al.

    The importance of physician encouragement in breast cancer screening of older women

    Prev Med

    (1992)
  • KE Grady et al.

    Clinical decision-making and mammography referral

    Prev Med

    (1996)
  • JAMA

    (1990)
  • BA Bartman et al.

    Women's primary care in the United States: a study of practice variation among physician specialties

    J Women's Health

    (1993)
  • CA Cancer J Clin

    (1990)
  • NL Lurie et al.

    Preventive care for women: does the sex of the physician matter?

    N Engl J Med

    (1993)
  • J Zapka et al.

    Breast screening by mammography: utilization and associated factors

    Am J Public Health

    (1989)
  • DS Lane et al.

    Effect of continuing medical education and cost reduction on physician compliance with mammography screening guidelines

    J Fam Pract

    (1991)
There are more references available in the full text version of this article.

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    All were in a favorable direction, with a median increase of 7.9% (IQI, 6.0%–12.0%). Increases in recommended or ordered screening by mammography ranged from 7.0% to 38.0% (six studies)43,50–54; by Pap 3.0%–23.0% (five studies)51–54,62; and by FOBT 4.0%–33.0% (three studies).51,53,54 The same body of evidence was used to evaluate the applicability of these interventions in different settings and in different provider and client populations.

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This research was supported by National Cancer Institute Grant CA58243.

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To whom correspondence and reprint requests should be addressed at the Massachusetts Institute of Behavioral Medicine, Inc., 180 Denslow Road, East Longmeadow, MA 01028. Fax: 413/525-8090.

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