COMMUNITY ORGANIZATION TO PROMOTE BREAST-CANCER SCREENING ORDERING BYPRIMARY-CARE PHYSICIANS

Community organization has been viewed as a promising approach to chan ging preventive behaviors. We evaluated the impact of community organi zation strategies to promote breast cancer screening ordering by prima ry care physicians in Washington State. Physicians practicing in two i ntervention and two control communities were surveyed by mail pre-inte rvention (1989) and post-intervention (1993). Intervention activities targeting the health care sector included the formation of local physi cian planning groups, a series of informational mailings, medical offi ce staff training sessions, and reminder system support. There were no significant post-intervention differences in the self-reported mammog raphy ordering of physicians practicing in the intervention and contro l areas. Over the four-year study period, the proportions of physician s who ordered regular mammography increased by 36%. By 1993, over 80% of the respondents routinely used mammographic screening. Concerns abo ut the high price of mammograms and inadequate insurance coverage were significantly reduced over time in both community pairs. Also, use of patient reminder systems increased significantly between 1989 and 199 3. Secular trends resulting from diffusion of strategies to promote ma mmography were responsible for increases in physician ordering of the procedure. Year 2000 goals for breast cancer screening use by physicia ns may already have been met in some communities.