在一家公立医院开展的旨在提高乳腺钼靶检查利用率的干预措施。
Intervention to increase mammography utilization in a public hospital.
作者信息
Davis T C, Berkel H J, Arnold C L, Nandy I, Jackson R H, Murphy P W
机构信息
Department of Internal Medicine, Louisiana State University Medical Center School of Medicine in Shreveport, 71130-3932, USA.
出版信息
J Gen Intern Med. 1998 Apr;13(4):230-3. doi: 10.1046/j.1525-1497.1998.00072.x.
OBJECTIVE
To study the effects of three approaches to increasing utilization of screening mammography in a public hospital setting in Northwest Louisiana.
DESIGN
Randomized intervention study.
POPULATION
Four hundred forty-five women aged 40 years and over, predominantly low-income and with low literacy skills, who had not had a mammogram in the preceding year.
INTERVENTION
All interventions were chosen to motivate women to get a mammogram. Group 1 received a personal recommendation from one of the investigators. Group 2 received the recommendation plus an easy-to-read National Cancer Institute (NCI) brochure. Group 3 received the recommendation, the brochure, and a 12-minute interactive educational and motivational program, including a soap-opera-style video, developed in collaboration with women from the target population.
MEASUREMENTS AND MAIN RESULTS
Mammography utilization was determined at 6 months and 2 years after intervention. A significant increase (p = .05) in mammography utilization was observed after the intervention designed in collaboration with patients (29%) as compared with recommendation alone (21%) or recommendation with brochure (18%) at 6 months. However, at 2 years the difference favoring the custom-made intervention was no longer significant.
CONCLUSIONS
At 6 months there was at least a 30% increase in the mammography utilization rate in the group receiving the intervention designed in collaboration with patients as compared with those receiving the recommendation alone or recommendation with brochure. Giving patients an easy-to-read NCI brochure and a personal recommendation was no more effective than giving them a recommendation alone, suggesting that simply providing women in a public hospital with a low-literacy-level, culturally appropriate brochure is not sufficient to increase screening mammography rates. In a multivariate analysis, the only significant predictor of mammography use at 6 months was the custom-made intervention.
目的
研究在路易斯安那州西北部一家公立医院中，三种提高乳腺钼靶筛查利用率方法的效果。
设计
随机干预研究。
研究对象
445名40岁及以上的女性，她们主要为低收入且文化程度较低，前一年未进行过乳腺钼靶检查。
干预措施
所有干预措施旨在促使女性进行乳腺钼靶检查。第1组收到一名研究人员的个人推荐。第2组收到推荐以及一份通俗易懂的美国国家癌症研究所（NCI）手册。第3组收到推荐、手册以及一个12分钟的互动式教育和激励项目，其中包括与目标人群中的女性合作制作的一部肥皂剧风格的视频。
测量指标及主要结果
在干预后6个月和2年时确定乳腺钼靶检查的利用率。与仅接受推荐（21%）或接受推荐加手册（18%）的组相比，在干预后6个月时，与患者合作设计的干预措施使乳腺钼靶检查利用率显著提高（p = 0.05）（29%）。然而，在2年时，有利于定制干预措施的差异不再显著。
结论
与仅接受推荐或接受推荐加手册的组相比，在干预后6个月时，接受与患者合作设计的干预措施的组中乳腺钼靶检查利用率至少提高了30%。给患者一份通俗易懂的NCI手册和个人推荐并不比仅给他们推荐更有效，这表明仅向公立医院中文化程度较低的女性提供一份符合文化背景的手册不足以提高乳腺钼靶筛查率。在多变量分析中，干预后6个月时乳腺钼靶检查使用的唯一显著预测因素是定制干预措施。
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