Phillips K A, Kerlikowske K, Baker L C, Chang S W, Brown M L
University of California-San Francisco 94105, USA.
Health Serv Res. 1998 Apr;33(1):29-53.
To examine individual and environmental factors associated with adherence to mammography screening guidelines.
A unique data set that combines a national probability sample (1992 National Health Interview Survey); a national probability sample of mammography facility characteristics (1992 National Survey of Mammography Facilities); county-level data on 1990 HMO market share; and county-level data on the supply of primary care providers (1991 Area Resource File).
The design was cross-sectional. DATA EXTRACTION/ANALYSIS: Data sets were linked to create an individual-level sample of women ages 50-74 (weighted n = 2,026). We used multipart, sequential logistic regression models to examine the predictors of having ever had mammography, having had recent mammography, and adherence to guidelines. We categorized women as adherent if they reported a lifetime number of exams appropriate for their age (based on screening every two years) and they reported having had an exam in the past two years.
Only 27 percent of women had the age-appropriate number of screening exams (range 16 percent-37 percent), while 59 percent of women had been screened within two years. Women were significantly more likely to adhere to screening guidelines if they reported participating with their doctor in the decision to be screened; were younger; had smaller families, higher education and income, and a recent Pap smear; reported breast problems; and lived in an area with a higher percentage of mammography facilities with reminder systems, no shortage of primary care providers, higher HMO market share, and higher screening charges.
A small percentage of women adhere to screening guidelines, suggesting that adherence needs to become a focus of clinical, programmatic, and policy efforts.
研究与乳腺钼靶筛查指南依从性相关的个体因素和环境因素。
一个独特的数据集，它结合了一个全国概率样本（1992年全国健康访谈调查）；一个乳腺钼靶检查设施特征的全国概率样本（1992年全国乳腺钼靶检查设施调查）；1990年健康维护组织（HMO）市场份额的县级数据；以及初级保健提供者供应情况的县级数据（1991年地区资源文件）。
采用横断面设计。数据提取/分析：将数据集进行链接，以创建一个50 - 74岁女性的个体层面样本（加权后n = 2,026）。我们使用多部分、序贯逻辑回归模型来研究曾经进行过乳腺钼靶检查、近期进行过乳腺钼靶检查以及遵循指南的预测因素。如果女性报告的终生检查次数符合其年龄（基于每两年筛查一次）且她们报告在过去两年内进行过检查，我们将其归类为依从者。
只有27%的女性进行了符合年龄的筛查次数（范围为16% - 37%），而59%的女性在两年内接受过筛查。如果女性报告与医生共同参与筛查决策；年龄较小；家庭规模较小、教育程度和收入较高且近期进行过巴氏涂片检查；报告有乳腺问题；并且居住在乳腺钼靶检查设施中设有提醒系统、初级保健提供者不短缺、HMO市场份额较高且筛查费用较高的地区，那么她们更有可能遵循筛查指南。
只有一小部分女性遵循筛查指南，这表明依从性需要成为临床、项目和政策努力的重点。
