Rappaport Karen M, Forrest Christopher B, Holtzman Neil A
Department of Pediatrics, Johns Hopkins Medical Institutions, Genetics and Public Policy Studies, Baltimore, MD 21205, USA.
Health Serv Res. 2004 Aug;39(4 Pt 1):927-47. doi: 10.1111/j.1475-6773.2004.00265.x.
To examine reasons for the adoption of liquid-based cervical cancer screening tests.
DATA SOURCES/STUDY SETTING: A mailed survey of 250 family physicians and 250 gynecologists in Maryland in 2000. Additional data were obtained from the AMA Master File of Physicians.
Key outcome variables in this cross-sectional survey were early adoption of a liquid-based test by the end of 1997 and overall adoption by the time of the survey. Adoption was viewed in terms of a supply and demand theoretical framework with marketing influencing physician and patient demand as well as supply by insurance companies and laboratories.
Random samples of family physicians and gynecologists were selected from the AMA Master File of Physicians. The overall response rate was 61.9 percent.
By 2000, 96 percent of gynecologists and 75 percent of family physicians in Maryland were using liquid-based cervical cancer screening tests, most commonly the ThinPrep Pap Test. Gynecologists were more likely than family physicians to have been early adopters (34 percent versus 5 percent, p<.01). Part of this variation in adoption was due to aggressive marketing to gynecologists, who were more likely than family physicians to receive information in the mail from the test manufacturer (89 percent versus 56 percent, p<.01) and to have been informed by the manufacturer that a patient had inquired about physicians' use of the test (22 percent versus 8 percent, p<.01).
The rapid diffusion of liquid-based cervical cancer screening tests occurred despite general agreement that the Pap smear has been one of the most successful cancer prevention interventions ever. Commercial marketing campaigns appear to contribute to the more rapid rate of diffusion of technology among specialists compared with generalists.
探究采用液基宫颈癌筛查检测的原因。
数据来源/研究背景：2000年对马里兰州250名家庭医生和250名妇科医生进行的邮寄调查。其他数据来自美国医学协会医生主文件。
在这项横断面调查中，关键结果变量是到1997年底早期采用液基检测以及到调查时的总体采用情况。采用情况是根据供需理论框架来看待的，其中营销影响医生和患者需求以及保险公司和实验室的供应。
从美国医学协会医生主文件中选取家庭医生和妇科医生的随机样本。总体回复率为61.9%。
到2000年，马里兰州96%的妇科医生和75%的家庭医生在使用液基宫颈癌筛查检测，最常用的是薄层液基细胞学检测。妇科医生比家庭医生更有可能是早期采用者（34%对5%；p<0.01）。采用情况的部分差异是由于对妇科医生进行了积极的营销，妇科医生比家庭医生更有可能收到检测制造商邮寄的信息（89%对56%；p<0.01），并且制造商告知他们有患者询问医生对该检测的使用情况（22%对8%；p<0.01）。
尽管人们普遍认为巴氏涂片检查是有史以来最成功的癌症预防干预措施之一，但液基宫颈癌筛查检测仍迅速普及。与全科医生相比，商业营销活动似乎促使技术在专科医生中传播得更快。
