Missed cancer screening opportunities among older women - A provider survey
Missed cancer screening opportunities among older women - A provider survey
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DOI：
10.1046/j.1523-5394.1998.006006325.x
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发表时间：
1998-11-01
期刊：
影响因子：
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通讯作者：
Kent, EB
中科院分区：
文献类型：
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作者：
Gulitz, E;Bustillo-Hernandez, M;Kent, EB
目的：缺乏医生推荐是乳腺癌和宫颈癌筛查未充分利用的主要预测因素。作者对佛罗里达州的初级保健提供者进行了全面的两部分研究，以确定哪些提供者没有对老年患者进行筛查及其原因。本文报告了该研究的定量调查部分。研究描述：在向随机抽样的2052名持证医学和骨科医生、执业护士和持证助产士邮寄调查问卷后，后续邮寄和电话调查结果为496份可用调查。结果变量是初级保健提供者是否对年龄大于50岁的无症状女性患者进行筛查试验。预测变量包括：年龄，种族，性别，培训，专业，执业规模，提供者的位置，以及他们所服务的老年患者的百分比。结果：初级保健提供者不筛查年龄大于50岁的无症状女性患者的最佳预测因子是年龄大于50岁、专门从事老年病学或成人健康、在小型或农村诊所工作的提供者。一项对提供者对与他们自己和他们的病人关于筛查的属性相关的结构化调查项目的回应的分析表明，由于病人、提供者、实践和访问障碍的结合，提供者经常错过筛查的机会。临床意义：作者建议公共卫生和初级保健从业者合作制定战略，解决克服这四个障碍的潜在变化领域，同时也考虑评估、政策制定和保证的基本公共卫生服务。这些战略的设计应促进对提供者和患者的乳腺癌和宫颈癌筛查过程，以便提供者更放心地执行和推荐这些重要的检查，特别是对服务不足的老年妇女群体。
PURPOSE: Lack of physician recommendation is a major predictor of underutilization of breast and cervical cancer screening. The authors conducted a comprehensive two-part study of Florida primary care providers to determine which providers were not screening their older patients and why. This article reports on the study's quantitative survey component.DESCRIPTION OF STUDY: After an initial mailing of surveys to 2052 randomly sampled, licensed medical and osteopathic physicians, nurse practitioners, and certified nurse midwives, a follow-up mailing and phone calls resulted in 496 usable surveys. Outcome variables were whether or not primary care providers performed screening tests for their asymptomatic, women patients older than 50 years of age. Predictor variables included: age, race, gender, training, speciality, practice size, and location of the providers, and the percentage of older patients that they served.RESULTS: The best predictors of primary care providers not screening their asymptomatic women patients who were older than 50 years of age were providers also being older than 50, specializing in geriatrics or adult health, and working in a small or rural practice. An analysis of providers' responses to structured survey items related to their own and their patients' attributes about screening indicated that providers often miss the opportunity to screen due to a combination of patient, provider, practice, and access barriers.CLINICAL IMPLICATIONS: The authors recommend that public health and primary care practitioner collaborate in developing strategies that address areas of potential change for overcoming these four barriers, while also considering the essential public health services of assessment, policy development, and assurance. These strategies should be designed to facilitate the breast and cervical cancer screening process for both providers and patients, so that providers feel more comfortable performing and recommending these important tests, particularly for underserved groups of older women.