Lane D S, Zapka J, Breen N, Messina C R, Fotheringham D J
Department of Preventive Medicine, School of Medicine, SUNY at Stony Brook, Stony Brook, New York 11794-8036, USA.
Prev Med. 2000 Nov;31(5):481-93. doi: 10.1006/pmed.2000.0747.
In older women covered by Medicare, relationships among physician recommendation, mammography in the past 2 years, and clinical breast examination (CBE) in the past year were systematically explored with a variety of predisposing, enabling, and situational factors identified in the Systems Model of Clinical Preventive Care.
A population-based survey of women age 65 years and older was conducted in five National Cancer Institute's Breast Cancer Screening Consortium geographic areas. Analyses focused on women with a regular physician and site of care (n = 5318).
Physician recommendation and mammography use declined with women's increasing age and increased with income, education, and insurance. CBE and mammography increased with number of physicians and breast cancer family history; mammography use decreased with worsening health status. Recommendations were higher among physicians who were younger, female, and internists. Family practitioners were older and male; women who saw family practitioners reported characteristics associated with decreased screening-lower income, education, and insurance-and seeing only one physician.
Public policy and health system changes that create a uniform system of finance and service performance expectations may reduce the persistent discrepancy in physician recommendation and mammography use due to sociodemographics and physician specialty.
在参加联邦医疗保险的老年女性中，我们运用临床预防保健系统模型中确定的各种诱发因素、促成因素和情境因素，系统地探究了医生建议、过去两年内的乳房X光检查以及过去一年内的临床乳房检查之间的关系。
在国家癌症研究所乳腺癌筛查联盟的五个地理区域，对65岁及以上的女性进行了一项基于人群的调查。分析重点关注有固定医生和就医地点的女性（n = 5318）。
随着女性年龄的增长，医生建议和乳房X光检查的使用率下降，而随着收入、教育程度和保险水平的提高而上升。临床乳房检查和乳房X光检查的使用率随着医生数量和乳腺癌家族史的增加而上升；乳房X光检查的使用率随着健康状况的恶化而下降。在年轻、女性和内科医生中，建议率更高。家庭医生年龄较大且多为男性；看家庭医生的女性报告的特征与筛查率降低有关——收入、教育程度和保险水平较低，且只看一位医生。
通过公共政策和卫生系统变革建立统一的财务和服务绩效期望体系，可能会减少因社会人口统计学和医生专业而导致的医生建议和乳房X光检查使用率方面持续存在的差异。
