School of Nursing, University of Minnesota, Minneapolis, Minnesota.
Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota.
J Womens Health (Larchmt). 2020 Jan;29(1):91-99. doi: 10.1089/jwh.2018.7436. Epub 2019 Jul 16.
Breast cancer screening practices and the influence of clinical guidelines or recommendations are well documented for physicians, but little is known about the screening practices of nonphysician providers (physician assistants and advanced practice registered nurses). The seven breast cancer screening guidelines or recommendations on the use of mammography have the most variation for screening average-risk women 40-49 years of age. Therefore, to better understand the practices of nonphysicians, this study will compare the practices of physicians with nonphysician providers for women 40-49 years of age. Minnesota physicians and nonphysicians were e-mailed an anonymous cross-sectional survey, which asked primary care providers about their mammography screening practices for average-risk women 40-44 and 45-49 years of age and to rate the influence of seven breast cancer screening recommendations on the use of mammography in their practice. Comparisons across providers' demographic and professional characteristics were conducted using chi-squared and Fisher's exact tests, as appropriate, and multivariate logistic regression analyses. Of the respondents who practiced primary care (193 physicians, 50 physician assistants, and 197 advanced practice registered nurses), 66.7% reported recommending mammography for women at ages 40-44 and 77.2% recommended mammography for women at ages 45-49. Nonphysician providers were more likely to recommend screening in both these age groups ( < 0.05). Having a self-identified interest in women's health was associated with more mammography screening in both age groups. The American Cancer Society guideline was endorsed as influential by the most respondents. Breast cancer screening practices vary between physicians and nonphysician providers for women 40-49 years of age at average risk. Targeted interventions may help reduce practice variation and ensure high-value care.
乳腺癌筛查实践以及临床指南或建议对医生的影响已有大量记录，但对于非医师提供者（医师助理和高级实践注册护士）的筛查实践却知之甚少。在为 40-49 岁的普通风险女性进行乳房 X 线筛查方面，有 7 项乳腺癌筛查指南或建议存在最大差异。因此，为了更好地了解非医师的实践情况，本研究将比较医师与非医师提供者在 40-49 岁女性中的实践情况。明尼苏达州的医生和非医生收到了一份匿名的横断面调查电子邮件，该调查询问了初级保健提供者他们对 40-44 岁和 45-49 岁普通风险女性的乳房 X 线筛查实践情况，并对 7 项乳腺癌筛查建议对他们实践中使用乳房 X 线检查的影响进行了评分。使用卡方检验和 Fisher 精确检验（如适用）以及多变量逻辑回归分析对提供者的人口统计学和专业特征进行了比较。在从事初级保健的受访者中（193 名医生、50 名医师助理和 197 名高级实践注册护士），有 66.7%的人建议对 40-44 岁的女性进行乳房 X 线检查，77.2%的人建议对 45-49 岁的女性进行乳房 X 线检查。非医师提供者更有可能在这两个年龄段都推荐筛查（ < 0.05）。对女性健康有自我认同的兴趣与这两个年龄段的更多乳房 X 线筛查相关。大多数受访者认为美国癌症协会的指南具有影响力。在普通风险的 40-49 岁女性中，医生和非医师提供者的乳腺癌筛查实践存在差异。有针对性的干预措施可能有助于减少实践差异，确保提供高价值的医疗服务。
