EFFECTIVENESS OF INTERVENTIONS TO ENHANCE PHYSICIAN SCREENING FOR BREAST-CANCER

Background. Physician recommendation is one of the strongest predictor s of mammography use. This study was designed to review research artic les assessing the effectiveness of interventions to enhance physician breast cancer screening behavior. Methods. A MEDLINE search was conduc ted to identify intervention studies published from January 1980 to Ap ril 1993. The search was supplemented by review of all related bibliog raphic references and recent listings in Current Contents.Results. Eff ect sizes and 95% confidence intervals were calculated for the 20 cont rolled trials identified by the search. The majority of studies were c onducted in academic settings; two were community-based. Interventions included physician reminder systems, other office systems, audit with feedback, and physician education. The majority of trials included tw o or more intervention modalities; 65% included physician reminder sys tems. In university settings, physician reminders and audit with feedb ack each significantly increased use of mammography and clinical breas t examination by approximately 5% to 20%. In community-based settings, the effects of physician education also had a positive impact on mamm ography and clinical breast examination rates, which ranged from 6% to 14%. Using patient education to influence physician behavior was not effective in university settings, but had a modest impact: in communit y trials. Generally, reminders were more cost-efficient than audit wit h feedback. Conclusions. Physician-based interventions can be effectiv e in increasing screening use. Interventions should emphasize communit y practices and practices caring for underserved and older populations .