Wheat M E, Kunitz G, Fisher J
Department of Medicine, Mount Zion Medical Center, San Francisco, California.
Am J Prev Med. 1990 May-Jun;6(3):130-6.
To explore physician, patient, and provider factors associated with house staff performance of cancer screening in women, we reviewed 565 randomly selected charts of 58 medical residents in two San Francisco teaching hospitals, H1 and H2. We assessed performance of Pap smear, breast exam, mammography, rectal exam, and stool occult blood testing, and administered questionnaires to all residents to ascertain screening beliefs and attitudes and individual screening criteria. The main finding was a significant difference in screening between the two hospitals. Four of five tests (Pap smear, breast exam, mammography, rectal exam) were performed more frequently at H2. Neither provider nor patient factors could explain this. Organizational differences between the sites included more frequent flow sheet recommendations for mammography and rectal exams at H2. Increased gynecological referral at H2 was also associated with more frequent Pap smears, breast exams, and rectal exams. White women did receive more frequent rectal exams, and mammography was increased among those who agreed with American Cancer Society screening recommendations, but no other provider or patient characteristics were associated with difference in screening. Results of further study of the effect of the learning environment and referral strategies on cancer screening, including assessment of patient acceptability and cost, can be used to improve cancer screening behaviors of medical house staff.
为探究与住院医师对女性癌症筛查工作表现相关的医生、患者及医疗服务提供者因素，我们在旧金山的两家教学医院H1和H2中，随机抽取了58名住院医师的565份病历进行回顾。我们评估了巴氏涂片检查、乳房检查、乳房X光检查、直肠检查和大便潜血试验的执行情况，并向所有住院医师发放问卷，以确定其筛查观念、态度及个人筛查标准。主要发现是两家医院在筛查方面存在显著差异。五项检查中的四项（巴氏涂片检查、乳房检查、乳房X光检查、直肠检查）在H2医院执行得更为频繁。无论是医疗服务提供者因素还是患者因素都无法解释这一现象。两家医院在组织方面的差异包括H2医院更频繁地在流程表上推荐乳房X光检查和直肠检查。H2医院增加的妇科转诊也与更频繁的巴氏涂片检查、乳房检查和直肠检查相关。白人女性确实接受了更频繁的直肠检查，并且那些认同美国癌症协会筛查建议的人接受乳房X光检查的比例更高，但没有其他医疗服务提供者或患者特征与筛查差异相关。对学习环境和转诊策略对癌症筛查的影响进行进一步研究的结果，包括对患者接受度和成本的评估，可用于改善住院医师的癌症筛查行为。
