Preisser J S, Cohen S J, Wofford J L, Moran W P, Shelton B J, McClatchey M W, Wolfe P
Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Arch Fam Med. 1998 Jul-Aug;7(4):346-51. doi: 10.1001/archfami.7.4.346.
Because of a strong association between health maintenance visits (HMVs) and cancer screening, knowledge of the predictors of an HMV have implications for screening.
To examine the association of an HMV with patient, physician, and practice characteristics in the primary care setting.
A statewide study of cancer screening was conducted in Colorado to determine concordance with the National Cancer Institute's guidelines for screening for breast, cervical, prostate, and skin cancer. Medical records form patients were randomly chosen from primary care practices. Predictors of an HMV were determined by fitting a logistic model to baseline data, adjusting for the cluster sampling of patients within practices.
Nonacademic primary care practices in Colorado.
A total of 5746 patients aged 42 to 74 years from 132 primary care practices.
Whether a patient had an HMV in the previous year.
Of all patients, 31% had an HMV in the previous year. Patient characteristics associated with having HMVs included nonsmoking status, odds ratio (OR) (95% confidence interval [CI]) of 1.27 (1.11-1.46), age, and sex. Women aged 50 to 69 years were significantly more likely to have an HMV than men aged 50 to 69 years (OR, 1.30; 95% CI, 1.10-1.54). Among adults aged 70 years and older, there were no significant sex differences in receiving HMVs. Physician and practice characteristics associated with providing HMVs included practice size (> or = 3 full-time physicians) (OR, 1.34; 95% CI, 1.01-1.77), physician contemplation of changing approaches to cancer screening (OR, 1.33; 95% CI, 1.04-1.70), and physician female sex (OR, 1.33; 95% CI, 1.04-1.70). Physician age and specialty (general internist or family physician) were not associated with the level of health maintenance delivery.
Certain subgroups, such as smokers, patients in smaller practices, and physicians not yet considering changing their approach to cancer screening, could be targeted in future intervention studies designed to provide preventive services in primary care settings.
由于健康维护就诊（HMV）与癌症筛查之间存在密切关联，了解HMV的预测因素对筛查具有重要意义。
探讨在初级保健环境中HMV与患者、医生及医疗实践特征之间的关联。
在科罗拉多州开展了一项全州范围的癌症筛查研究，以确定是否符合美国国立癌症研究所关于乳腺癌、宫颈癌、前列腺癌和皮肤癌筛查的指南。从初级保健机构随机选取患者的病历。通过对基线数据拟合逻辑模型来确定HMV的预测因素，并对机构内患者的整群抽样进行调整。
科罗拉多州的非学术性初级保健机构。
来自132家初级保健机构的共5746名年龄在42至74岁之间的患者。
患者在前一年是否进行了健康维护就诊。
在所有患者中，31%的人在前一年进行了HMV。与进行HMV相关的患者特征包括不吸烟状态，比值比（OR）（95%置信区间[CI]）为1.27（1.11 - 1.46）、年龄和性别。50至69岁的女性比50至69岁的男性进行HMV的可能性显著更高（OR，1.30；95% CI，1.10 - 1.54）。在70岁及以上的成年人中，接受HMV方面不存在显著的性别差异。与提供HMV相关的医生及医疗实践特征包括机构规模（≥3名全职医生）（OR，1.34；95% CI，1.01 - 1.77）、医生对改变癌症筛查方法的考虑（OR，1.33；95% CI，1.04 - 1.70）以及医生为女性（OR，1.33；95% CI，1.04 - 1.70）。医生年龄和专业（普通内科医生或家庭医生）与健康维护服务水平无关。
某些亚组，如吸烟者、规模较小机构的患者以及尚未考虑改变癌症筛查方法的医生，可作为未来旨在在初级保健环境中提供预防服务的干预研究的目标人群。
