ENHANCING MAMMOGRAPHY REFERRAL IN PRIMARY-CARE

Background. This 1-year randomized trial tested the efficacy of behavi oral techniques for increasing mammography referrals by primary care p hysicians 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 st ickers, and (3) education plus cue enhancement plus feedback and token rewards. Quarterly chart audits of a defined sample (N = 11,716) of w omen patients 50 years of age or older were conducted to document mamm ography referrals, completions, and compliance. Results. Referral and completion rates increased from baseline to first quarter and graduall y declined thereafter. Overall, these rates were higher in the cuing c onditions than in the control condition. In contrast, compliance rates in both experimental conditions increased over the year while remaini ng static in the control condition, demonstrating a strong and continu ing effect for cue enhancement. Compliance increases were greatest for physicians who were older, nonwhite, with a second speciality, in sol o practice, not members of the AMA, not residency trained, and not boa rd certified. Conclusions. Chart stickers can significantly increase m ammography utilization in small, community practices. These practices are an efficient route to reaching large numbers of older women in nee d of mammography screening. (C) 1997 Academic Press.