Beaulieu M D, Béland F, Roy D, Falardeau M, Hébert G
Department of Family Medicine, Hopital Notre-Dame, Montreal, Que.
CMAJ. 1996 May 1;154(9):1335-43.
To determine factors affecting compliance with screening mammography prescribed by family physicians.
Secondary analysis of a nonrandomized trial.
University-affiliated family medicine clinic in Montreal.
Women aged 50 to 69 years who were given a written prescription for a screening mammography during their visit at the clinic between Oct. 12, 1991, and May 31, 1992, and who had not undergone mammography in the preceding 2 years and had never been treated for breast cancer. Information on the potential factors was obtained through a telephone questionnaire 2 months after the visit.
Indicator of compliance presence of result of screening mammography in patient chart, potential factors influencing compliance: age, level of education, marital status, socioeconomic level, smoking status, perceived health status, perceived psychological well-being, risk factors for breast cancer, use of health services including frequency of Papanicolaou test, Health Belief Model variables.
Of the 171 eligible women, 113 (66.1%) underwent the prescribed mammography within 2 months after the visit to the clinic, and 149 (87.1%) responded to the questionnaire. The patients' socioeconomic characteristics, perceived health status, health utilization indices and risk factors for breast cancer were not found to be predictors of compliance. The strongest predictor of compliance was the number of previous mammograms. Women who had undergone mammography previously were less likely to be noncompliant than those who had not (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02 to 0.51; p = 0.005). Women who did not comply were less likely than those who did to believe that a prescription from their physician would convince them to undergo mammography (OR 0.21, 95% CI 0.007 to 0.60; p = 0.004). Other factors associated with noncompliance were the expression of fear of mammography (OR 2.09, 95% CI 1.08 to 4.02; p = 0.03) and the lack of time to take the test (OR 3.07, 95% CI 1.21 to 7.80 p = 0.02). Being a smoker was negatively associated with compliance (OR 0.43; 95% CI 0.22 to 0.86; p = 0.02). The stepwise logistic regression model accounted for 87.5% of the outcome (chi2 for goodness of fit = 164.4; p = 0.0001).
Family physicians who prescribe screening mammography, even to women who consult for other reasons, are likely to overcome some of the barriers observed in association with population screening rates. However, physician-oriented approaches are not likely to reach the 30% to 40% of reluctant women who appear to hold negative views toward physicians' recommendations. Further study is necessary to determine how better to reach these women.
确定影响家庭医生所开乳腺钼靶筛查医嘱依从性的因素。
对一项非随机试验进行二次分析。
蒙特利尔一家大学附属家庭医学诊所。
年龄在50至69岁之间的女性，她们于1991年10月12日至1992年5月31日在该诊所就诊期间收到了乳腺钼靶筛查的书面医嘱，且在之前两年内未进行过乳腺钼靶检查，也未曾接受过乳腺癌治疗。在就诊两个月后通过电话问卷获取有关潜在因素的信息。
依从性指标（患者病历中乳腺钼靶筛查结果的存在情况），影响依从性的潜在因素：年龄、教育程度、婚姻状况、社会经济水平、吸烟状况、自我感知健康状况、自我感知心理健康状况、乳腺癌风险因素、包括巴氏试验频率在内的医疗服务利用情况、健康信念模式变量。
在171名符合条件的女性中，113名（66.1%）在就诊后两个月内接受了规定的乳腺钼靶检查，149名（87.1%）回复了问卷。未发现患者的社会经济特征、自我感知健康状况、医疗服务利用指标和乳腺癌风险因素是依从性的预测因素。依从性最强的预测因素是既往乳腺钼靶检查的次数。既往接受过乳腺钼靶检查的女性比未接受过的女性更不易出现不依从情况（比值比[OR]0.11，95%置信区间[CI]0.02至0.51；p = 0.005）。不依从的女性比依从的女性更不相信医生的医嘱会促使她们接受乳腺钼靶检查（OR 0.21，95%CI 0.007至0.60；p = 0.004）。与不依从相关的其他因素包括对乳腺钼靶检查的恐惧表达（OR 2.09，95%CI 1.08至4.02；p = 0.03）和没有时间进行检查（OR 3.07，95%CI 1.21至7.80；p = 0.02）。吸烟与依从性呈负相关（OR 0.43；95%CI 0.22至0.86；p = 0.02）。逐步逻辑回归模型解释了87.5%的结果（拟合优度的卡方值=164.4；p = 0.0001）。
开具乳腺钼靶筛查医嘱的家庭医生，即使是给因其他原因就诊的女性开具医嘱，也有可能克服一些与人群筛查率相关的障碍。然而，以医生为导向的方法不太可能影响30%至40%那些似乎对医生建议持负面看法的不情愿女性。有必要进行进一步研究以确定如何更好地影响这些女性。
