A systems model of clinical preventive care: The case of breast cancer screening among older women

Background. In older women covered by Medicare, relationships among physici an recommendation, mammography in the past 2 years, and clinical breast exa mination (CBE) in the past year were systematically explored with a variety of predisposing, enabling, and situational factors identified in the Syste ms Model of Clinical Preventive Care. Methods. A population-based survey of women age 65 years and older was cond ucted in five National Cancer Institute's Breast Cancer Screening Consortiu m geographic areas. Analyses focused on women with a regular physician and site of care (n = 5318), Results. Physician recommendation and mammography use declined with women's increasing age and increased with income, education, and insurance. CBE an d mammography increased with number of physicians and breast cancer family history; mammography use decreased with worsening health status, Recommenda tions were higher among physicians who were younger, female, and internists , Family practitioners were older and male; women who saw family practition ers reported characteristics associated with decreased screening-lower inco me, education, and insurance-and seeing only one physician, Conclusions, Public policy and health system changes that create a uniform system of finance and service performance expectations may reduce the persi stent discrepancy in physician recommendation and mammography use due to so ciodemographics and physician specialty. (C) 2000 American Health Foundatio n and Academic Press.