Methodology for targeting physicians for interventions to improve breast cancer screening

Introduction: Uneven increases in mammography utilization rates call for me thods to efficiently target educational interventions to women who do not r egularly use mammography and physicians who do not adhere to national guide lines for breast cancer screening. This paper discusses a method for identi fying physicians who are nonadherers to breast cancer screening guidelines or in need of continuing medical education (CME) in this area. Methods: A 1995 community-based telephone survey of randomly selected women aged 50-80, residing in four Long Island, NY, townships was used to identi fy women who underuse mammography and their regular physicians. Community-b ased surveys of physicians permitted identification of nonadherent provider s. Nonadherence to breast cancer screening recommendations was the primary criterion, but because of anticipated physician reluctance to self report n onadherence with screening guidelines, additional criteria were developed t o identify physicians with educational needs relating to breast cancer scre ening. These criteria included lack of office reminder systems and knowledg e relating to breast cancer screening, and lack of confidence in patient co unseling and clinical breast examination skills. Results: Overall response rates were 77% for women's survey, and 66% for th e physician survey. 3427 women were classified as underusers (38.5%) and 87 % of underusers provided the name and address of their regular physicians. By physician self report, 45% of physicians were classified as nonadherers and 42% were identified as having related educational needs. Conclusions: A feasible method for identifying physicians who are nonadhere rs to breast cancer screening recommendations or in need of CME about this is described, permitting efficient targeting of educational interventions t o those with patients who underuse mammography. The method is not dependent on access to a specific provider or patient population. (C) 1999 American Journal of Preventive Medicine.