McCarthy B D, Yood M U, Janz N K, Boohaker E A, Ward R E, Johnson C C
Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Cancer. 1996 May 15;77(10):2070-6. doi: 10.1002/(SICI)1097-0142(19960515)77:10<2070::AID-CNCR16>3.0.CO;2-S.
To increase the proportion of women who receive the recommended follow-up for mammographic abnormalities, factors which inhibit follow-up must be identified. Patient and health care delivery related factors were evaluated, stratified by type of follow-up recommendation, to determine reasons for inadequate follow-up.
All Caucasian and African American women at the Henry Ford Medical Group, in southeastern Michigan, with an abnormal screening mammogram result between January 1, 1992 and July 31, 1992 were identified. All women with inadequate follow-up, and a random sample of women with adequate follow-up, were invited to participate in a telephone interview that assessed three major dimensions of the Health Belief Model (susceptibility, benefits, and barriers), general health and health behaviors, and related characteristics. The relationship between these factors and inadequate follow-up was evaluated separately for women with immediate and 6-month follow-up recommendations, using univariate and multivariate analyses.
A total of 555 women were invited to participate in the study (219 with inadequate follow-up and 336 with adequate follow-up). Interviews were completed for 418 women (75.3%). Women who were not notified of their mammographic abnormality were excluded from this study, leaving 399 women available for analysis. Among the women who had the recommended immediate follow-up, those who reported difficulty in obtaining medical appointments were 4 times more likely to have inadequate follow-up (95% confidence interval [CI] 1.5, 11.3), after adjusting for other variables. Among the women with six-month follow-up recommended, those who received fewer mammograms in the past 5 years were more likely to have inadequate follow-up (odds ratio [OR] = 4.0; 95% CI 1.6, 10.4). In this group, sociodemographic characteristics were not associated with inadequate follow-up, although women with transportation problems were at a higher risk (crude OR = 5.2; 95% CI 1.6, 16.7; adjusted OR = 3. 1; 95% CI 0.5, 18.3). Among women with 6-month follow-up recommended, those who perceived their health as poor or fair (crude OR = 2.4; 95% CI 1.2, 5.1; adjusted OR = 2.3; 95% CI 0.8, 6.8) and those who did not examine their own breasts frequently (crude OR = 2.3; 95% CI 1.0, 5.4; adjusted OR = 2.7; 95% CI 0.5, 18.3) were also more likely to have inadequate follow-up.
Results from this study demonstrate that the relative importance of factors associated with inadequate follow-up of abnormal mammograms differs according to the type of follow-up recommended. For both types of recommendations, the factors identified are noteworthy because they are amenable to intervention. Efforts should be made to facilitate appointment scheduling for follow-up of abnormal mammograms, and information about previous mammography screening should be obtained to identify women who are at a high risk for inadequate follow-up.
为提高接受乳腺钼靶异常推荐随访的女性比例，必须确定阻碍随访的因素。按随访推荐类型对患者及医疗服务相关因素进行评估，以确定随访不足的原因。
确定了1992年1月1日至1992年7月31日期间密歇根州东南部亨利福特医疗集团所有乳腺钼靶筛查结果异常的白种人和非裔美国女性。邀请所有随访不足的女性以及随访充足的女性随机样本参加电话访谈，该访谈评估了健康信念模型的三个主要维度（易感性、益处和障碍）、一般健康状况和健康行为以及相关特征。使用单变量和多变量分析，分别对有立即随访和6个月随访推荐的女性，评估这些因素与随访不足之间的关系。
共有555名女性受邀参加该研究（219名随访不足，336名随访充足）。418名女性（75.3%）完成了访谈。未被告知其乳腺钼靶异常的女性被排除在本研究之外，剩余399名女性可供分析。在有立即随访推荐的女性中，在调整其他变量后，报告难以获得医疗预约的女性随访不足的可能性高4倍（95%置信区间[CI]1.5，11.3）。在有6个月随访推荐的女性中，过去5年接受乳腺钼靶检查较少的女性更有可能随访不足（优势比[OR]=4.0；95%CI 1.6，10.4）。在该组中，社会人口学特征与随访不足无关，尽管有交通问题的女性风险更高（粗OR=5.2；95%CI 1.6，16.7；调整后OR=3.1；95%CI 0.5，18.3）。在有6个月随访推荐的女性中，认为自己健康状况差或一般的女性（粗OR=2.4；95%CI 1.2，5.1；调整后OR=2.3；95%CI 0.8，6.8）以及不经常自我检查乳房的女性（粗OR=2.3；95%CI 1.0，5.4；调整后OR=2.7；95%CI 0.5，18.3）也更有可能随访不足。
本研究结果表明，与乳腺钼靶异常随访不足相关的因素的相对重要性因推荐的随访类型而异。对于这两种类型的推荐，所确定的因素都值得关注，因为它们适合进行干预。应努力为乳腺钼靶异常的随访安排预约提供便利，并获取有关既往乳腺钼靶筛查的信息，以识别随访不足风险高的女性。
