FACTORS INFLUENCING MAMMOGRAM ORDERING AT THE TIME OF THE OFFICE VISIT

Background. Breast cancer is the second most common cause of cancer de ath in women, with mammographic screening the only modality shown to d ecrease the death rate. However, only 17% to 41% of women have ever be en screened, and multiple barriers to screening have been identified. This study examined physician and patient factors at a single encounte r to explore components influencing mammography ordering. Methods. Ten family physicians in a primary care research network completed daily data cards on encounters with women presenting for annual examinations , chronic problems, or breast-related complaints. Information collecte d included patient age, personal or family history of breast cancer, p hysician's perception of expected compliance, previous mammogram resul ts, breast examination, physician's perception of need for a mammogram , whether the mammogram was ordered, and the patients method of paymen t for the test. Results. Eight hundred thirty-nine Patients were enter ed into the study, and 277 mammograms were ordered. Mammograms were or dered for a greater percentage of patients with insurance (36%) than f or those without insurance (26%) (P < .001). A multivariate analysis i ndicated that several factors helped to correctly classify 90% of mamm ogram ordering: the patient was making a first visit, a breast-related visit, or a visit for an annual examination; the patient had had a pr evious mammogram; had a breast examination at the current visit or wit hin the past year; and the physician believed the patient would comply and believed that a mammogram was indicated. Conclusions. Factors uni que to a physician-patient visit influence the physician with regard t o ordering a mammogram, including the type of visit, whether the physi cian believes a mammogram is indicated, and the cost.