Haas Jennifer S, Barlow William E, Schapira Marilyn M, MacLean Charles D, Klabunde Carrie N, Sprague Brian L, Beaber Elisabeth F, Chen Jane S, Bitton Asaf, Onega Tracy, Harris Kimberly, Tosteson Anna N A
Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.
Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2017 Apr;32(4):449-457. doi: 10.1007/s11606-016-3973-y. Epub 2017 Jan 9.
Revised breast cancer screening guidelines have fueled debate about the effectiveness and frequency of screening mammography, encouraging discussion between women and their providers.
To examine whether primary care providers' (PCPs') beliefs about the effectiveness and frequency of screening mammography are associated with utilization by their patients.
Cross-sectional survey data from PCPs (2014) from three primary care networks affiliated with the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium, linked with data about their patients' mammography use (2011-2014).
PCPs (n = 209) and their female patients age 40-89 years without breast cancer (n = 30,233).
Outcomes included whether (1) women received a screening mammogram during a 2-year period; and (2) screened women had >1 mammogram during that period, reflecting annual screening. Principal independent variables were PCP beliefs about the effectiveness of mammography and their recommendations for screening frequency.
Overall 65.2% of women received >1 screening mammogram. For women 40-48 years, mammography use was modestly lower for those cared for by PCPs who believed that screening was ineffective compared with those who believed it was somewhat or very effective (59.1%, 62.3%, and 64.7%; p = 0.019 after controlling for patient characteristics). Of women with PCPs who reported they did not recommend screening before age 50, 48.1% were nonetheless screened. For women age 49-74 years, the vast majority were cared for by providers who believed that screening was effective. Provider recommendations were not associated with screening frequency. For women ≥75 years, those cared for by providers who were uncertain about effectiveness had higher screening use (50.7%) than those cared for by providers who believed it was somewhat effective (42.8%). Patients of providers who did not recommend screening were less likely to be screened than were those whose providers recommended annual screening, yet 37.1% of patients whose providers recommended against screening still received screening.
PCP beliefs about mammography effectiveness and screening recommendations are only modestly associated with use, suggesting other likely influences on patient participation in mammography.
修订后的乳腺癌筛查指南引发了关于乳腺钼靶筛查有效性和频率的争论，促使女性及其医疗服务提供者之间展开讨论。
探讨基层医疗服务提供者（PCP）对乳腺钼靶筛查有效性和频率的看法是否与其患者的筛查利用率相关。
来自基于人群的个性化筛查优化方案（PROSPR）联盟下属三个基层医疗网络的PCP（2014年）的横断面调查数据，与关于其患者乳腺钼靶检查使用情况（2011 - 2014年）的数据相链接。
PCP（n = 209）及其40 - 89岁无乳腺癌的女性患者（n = 30233）。
结果包括（1）女性在两年期间是否接受了乳腺钼靶筛查；（2）接受筛查的女性在此期间是否进行了超过1次乳腺钼靶检查，以反映年度筛查情况。主要自变量是PCP对乳腺钼靶检查有效性的看法及其对筛查频率的建议。
总体而言，65.2%的女性接受了超过1次乳腺钼靶筛查。对于40 - 48岁的女性，与那些认为筛查有效或非常有效的PCP所照顾的女性相比，那些由认为筛查无效的PCP照顾的女性的乳腺钼靶检查使用率略低（59.1%、62.3%和64.7%；在控制患者特征后p = 0.019）。在那些PCP报告不建议在50岁前进行筛查的女性中，仍有48.1%接受了筛查。对于49 - 74岁的女性，绝大多数由认为筛查有效的医疗服务提供者照顾。医疗服务提供者的建议与筛查频率无关。对于75岁及以上的女性，由对有效性不确定的医疗服务提供者照顾的女性的筛查使用率（50.7%）高于那些由认为筛查有点有效的医疗服务提供者照顾的女性（42.8%）。医疗服务提供者不建议筛查的患者比那些医疗服务提供者建议每年筛查的患者接受筛查的可能性更小，但37.1%的医疗服务提供者建议不筛查的患者仍接受了筛查。
PCP对乳腺钼靶检查有效性的看法和筛查建议与使用率仅存在适度关联，这表明可能还有其他因素影响患者参与乳腺钼靶筛查。
