Haggstrom David A, Phillips Kathryn A, Liang Su-Ying, Haas Jennifer S, Tye Sherilyn, Kerlikowske Karla
San Francisco General Hospital, Division of General Internal Medicine, University of California, San Francisco.
Cancer Causes Control. 2004 Nov;15(9):883-92. doi: 10.1007/s10552-004-1138-5.
To assess whether the specialty of a patient's primary care physician or being part of a gatekeeper plan influence breast and cervical cancer screening.
Cross-sectional study of women in a national sample. For mammography, we studied women aged 40 and above, and for Papanicolaou (Pap) smear, women aged 18-65 years. Screening mammography or Pap smear within the previous two years was measured by patient self-report. The key independent variables were primary care physician specialty and whether the patient had a gatekeeper.
Among women seen by a family practice physician, there was a higher probability of being screened if the patient was part of a gatekeeper plan than if the patient was not part of a gatekeeper plan: mammography (OR = 1.35; 95% CI = 1.20-1.52) and Pap smear (OR = 1.60; 95% CI = 1.34-1.91). Among women seen by an internal medicine physician, cancer screening did not vary significantly by gatekeeper status.
The impact of gatekeeper plans upon cancer screening varies according to the primary care physician's specialty. Policy interventions designed to increase cancer screening should take into account different responses to gatekeeper requirements among different types of providers.
评估患者初级保健医生的专业领域或参与守门人计划是否会影响乳腺癌和宫颈癌筛查。
对全国样本中的女性进行横断面研究。对于乳房X光检查，我们研究了40岁及以上的女性；对于巴氏涂片检查，研究了18 - 65岁的女性。过去两年内的乳房X光筛查或巴氏涂片检查通过患者自我报告来衡量。关键自变量是初级保健医生的专业领域以及患者是否有守门人。
在由家庭医生诊治的女性中，如果患者参与守门人计划，其接受筛查的可能性高于未参与守门人计划的患者：乳房X光检查（比值比[OR]=1.35；95%置信区间[CI]=1.20 - 1.52）和巴氏涂片检查（OR = 1.60；95% CI = 1.34 - 1.91）。在内科医生诊治的女性中，癌症筛查在守门人状态方面没有显著差异。
守门人计划对癌症筛查的影响因初级保健医生的专业领域而异。旨在增加癌症筛查的政策干预应考虑不同类型医疗服务提供者对守门人要求的不同反应。
