Effectiveness of interventions designed to increase mammography use: A meta-analysis of provider-targeted strategies

The objective of this study was to determine the effectiveness of intervent ions targeted at providers to enhance the use of mammography, We performed a meta-analysis and included United States studies that used a randomized o r nonrandomized concurrent control design, had defined outcomes, and presen ted data that could be abstracted for reanalysis. Interventions were classi fied as behavioral, cognitive, or sociological and further categorized by t he type of control group (active versus usual care). Data were combined usi ng DerSimonian and Laird random effects models to yield summary effect size s. Thirty-five studies met the inclusion criteria. All types of interventio ns targeted at providers were effective in increasing mammography rates. Be havioral interventions increased screening by 13.2% [95% confidence interva l (CI), 7.8-18.4] as compared with usual care and by 6.8% (95% CI, 4.8-8.7) as compared with active controls. Cognitive intervention strategies improv ed mammography rates by 18.6% (95% CI, 12.8-24.4), Sociological interventio ns also had a similar magnitude of effect on screening rates (13.1% increas e; 95% CI, 6.8-19.3), Interventions targeting both patients and providers w ere not significantly better at increasing screening than those targeting p roviders alone, and multiple approaches (e.g., behavioral and cognitive) we re generally not more effective than a single approach. All interventions t argeted at physicians were effective in increasing screening rates. Decisio ns to use a particular approach will depend on resources, expertise, feasib ility, and cost effectiveness.