Margolis K L, Lurie N, McGovern P G, Slater J S
Hennepin County Medical Center, Minneapolis, MN 55415.
J Gen Intern Med. 1993 Nov;8(11):602-5. doi: 10.1007/BF02599713.
To identify patient, institutional, and physician characteristics that predict failure to attend scheduled mammography appointments.
Retrospective chart review.
Medicine clinic at an urban public teaching hospital.
All 907 women aged 40 years and more scheduled for mammography from March 1990 to June 1991.
The main outcome measure was whether a woman kept her scheduled mammography appointment. Potential predictor variables included patient age, race, marital status, and insurance status; waiting interval to obtain a mammography appointment; and physician gender, level of training, country of training, and native language. The rate of failed mammography appointments was 23%. Univariate analysis showed that appointment failure was associated with age (p = 0.03), with the lowest failure rates (19%) among women aged 60 years and more. Appointment keeping varied significantly by race (p = 0.01), largely because of the higher failure rate among Native American women (36%). Insured women had a failure rate of 22% vs 33% for uninsured women (p = 0.01). The rate of failed appointments varied significantly by waiting interval (p = 0.05), with a peak failure rate of 27% for appointments scheduled 14-27 days in advance. None of the physician variables was associated with appointment failure. Multivariate analysis confirmed these results.
Interventions to improve completion of breast cancer screening should include additional efforts targeted at groups with high rates of appointment failure, such as women under the age of 60, the uninsured, and Native Americans. Long waiting intervals to obtain mammography appointments may decrease compliance.
确定能够预测未能按时参加乳腺钼靶检查预约的患者、机构和医生特征。
回顾性病历审查。
城市公立教学医院的内科门诊。
1990年3月至1991年6月期间所有907名年龄在40岁及以上且预约了乳腺钼靶检查的女性。
主要结果指标是女性是否按时参加乳腺钼靶检查预约。潜在预测变量包括患者年龄、种族、婚姻状况和保险状况；获得乳腺钼靶检查预约的等待时间；以及医生性别、培训水平、培训国家和母语。乳腺钼靶检查预约未成功的比例为23%。单因素分析显示，预约未成功与年龄相关（p = 0.03），60岁及以上女性的未成功比例最低（19%）。预约完成情况因种族而异（p = 0.01），主要原因是美国原住民女性的未成功比例较高（36%）。参保女性的未成功比例为22%，未参保女性为33%（p = 0.01）。预约未成功比例因等待时间而异（p = 0.05），提前14 - 27天预约的未成功比例最高，为27%。没有一项医生变量与预约未成功相关。多因素分析证实了这些结果。
旨在提高乳腺癌筛查完成率的干预措施应包括针对预约未成功比例较高的群体，如60岁以下女性、未参保者和美国原住民，做出更多努力。获得乳腺钼靶检查预约的等待时间过长可能会降低依从性。
