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The effect of a multifaceted physician office-based intervention on older women's mammography use
J A Preston1, J D Scinto, J N Grady
1Qualidigm, Middletown, Connecticut 06457, USA.
Background:
In response to identified low mammography use among older women in three geographic areas in Connecticut, a physician office-based mammography intervention was initiated under the Health Care Financing Administration's Health Care Quality Improvement Program.
Objective:
To evaluate the intervention's impact on older women's mammography use.
Design:
A quasi-experimental design comparing mammography rates for women in the intervention program with a randomly selected control sample.
Setting:
Community-based physician offices.
Patients:
Female Medicare beneficiaries aged 65 to 74 years seen by participating and control physicians for at least one primary care visit in 1995 (baseline) and 1996 (follow-up). In the baseline period, 1720 women in the intervention sample and 2761 women in the control sample were included in the study.
Intervention:
The recruitment strategies included the use of physician opinion leaders and modified academic detailing. The multifaceted intervention incorporated patient education, physician reminders, and audit-with-feedback
Measurements:
Biennial mammography rates. Patient adherence to physician mammography referral was evaluated in a restricted cohort of women selected from the intervention sample.
Results:
The mammography rate for the intervention sample increased from 62.7% (baseline) to 73.1% (follow-up), (P<.001), whereas the control sample's rate remained essentially unchanged (68.3 to 69.5%), (P = .34). The intervention patients were 48% more likely than controls to experience an increase in biennial mammography use (OR = 1.48; 95% CI, 1.22-1.79) after adjustment for patient race and income and physician gender, specialty, and age. The proportion of women who adhered to their physicians' mammography referral was 70.6%.
Conclusions:
These data demonstrate the effectiveness of a multifaceted intervention program administered in the setting of community physician practices. The relatively low rate of patients' acceptance of their physicians' mammography recommendations has identified the need to address more effectively older women's concerns about mammography screening.