The effect of a multifaceted physician office-based intervention on older women's mammography use

BACKGROUND: In response to identified low mammography use among older women in three geographic areas in Connecticut, a physician office-based mammogr aphy intervention was initiated under the Health Care Financing Administrat ion's Health Care Quality Improvement Program. OBJECTIVE: To evaluate the intervention's impact on older women's mammograp hy use. DESIGN: A quasi-experimental design comparing mammography rates for women i n the intervention program with a randomly selected control sample. SETTING: Community-based physician offices. PATIENTS: Female Medicare beneficiaries aged 65 to 74 years seen by partici pating and control physicians for at least one primary care visit in 1995 ( baseline) and 1996 (follow-up). In the baseline period, 1720 women in the i ntervention sample and 2761 women in the control sample were included in th e study. INTERVENTION: The recruitment strategies included the use of physician opin ion leaders and modified academic detailing. The multifaceted intervention incorporated patient education, physician reminders, and audit-with-feedbac k MEASUREMENTS: Biennial mammography rates. Patient adherence to physician ma mmography referral was evaluated in a restricted cohort of women selected f rom the intervention sample. RESULTS: The mammography rate for the intervention sample increased from 62 .7% (baseline) to 73.1% (follow-up), (P < .001), whereas the control sample 's rate remained essentially unchanged (68.3 to 69.5%), (P = .34). The inte rvention patients were 48% more likely than controls to experience an incre ase in biennial mammography use (OR = 1.48; 95% CI, 1.22-1.79) after adjust ment for patient race and income and physician gender, specialty, and age. The proportion of women who adhered to their physicians' mammography referr al was 70.6%. CONCLUSIONS: These data demonstrate the effectiveness of a multifaceted int ervention program administered in the setting of community physician practi ces. The relatively low rate of patients' acceptance of their physicians' m ammography recommendations has identified the need to address more effectiv ely older women's concerns about mammography screening.