Costanza M E, Zapka J G, Harris D R, Hosmer D, Barth R, Gaw V P, Greene H L, Stoddard A M
Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655.
Cancer Epidemiol Biomarkers Prev. 1992 Nov-Dec;1(7):581-9.
In order to improve compliance with the National Cancer Institute's breast cancer screening guidelines, we developed a multifaceted intervention designed to alter physician screening practice. A pre-post test, two-community design was used. Primary care physicians in one community served as the control. Data were collected by two mailed surveys (1987 and 1990). Response rates were 61% and 64%, respectively. The physician intervention program consisted of a hospital-based continuing medical education program and an outreach component which focused on implementing a reminder system. Outcome measures were self-reported attitudinal, knowledge, and screening practices changes. In spite of an impressive change in comparison community physicians' practice, the difference in change over time in the intervention community physicians' ordering of annual mammography compared to the change in the comparison community physicians' ordering was significant (P = 0.04). The adjusted odds ratio is nearly 8. We conclude that our in-service continuing medical education program was successful in improving breast cancer screening practices among primary care physicians.
为提高对美国国立癌症研究所乳腺癌筛查指南的依从性，我们开展了一项多方面的干预措施，旨在改变医生的筛查行为。采用了前后测试、双社区设计。一个社区的初级保健医生作为对照组。通过两次邮寄调查（1987年和1990年）收集数据。回复率分别为61%和64%。医生干预项目包括一个以医院为基础的继续医学教育项目和一个侧重于实施提醒系统的外展部分。结果指标是自我报告的态度、知识和筛查行为的变化。尽管比较社区医生的行为有显著变化，但干预社区医生每年乳腺钼靶检查的医嘱随时间的变化与比较社区医生医嘱的变化之间的差异具有统计学意义（P = 0.04）。调整后的优势比接近8。我们得出结论，我们的在职继续医学教育项目成功地改善了初级保健医生的乳腺癌筛查行为。
