Effectiveness of interventions to enhance physician screening for breast cancer.

BACKGROUND: Physician recommendation is one of the strongest predictors of mammography use. This study was designed to review research articles assessing the effectiveness of interventions to enhance physician breast cancer screening behavior.
METHODS: A MEDLINE search was conducted to identify intervention studies published from January 1980 to April 1993. The search was supplemented by review of all related bibliographic references and recent listings in Current Contents.
RESULTS: Effect sizes and 95% confidence intervals were calculated for the 20 controlled trials identified by the search. The majority of studies were conducted in academic settings; two were community-based. Interventions included physician reminder systems, other office systems, audit with feedback, and physician education. The majority of trials included two or more intervention modalities; 65% included physician reminder systems. In university settings, physician reminders and audit with feedback each significantly increased use of mammography and clinical breast examination by approximately 5% to 20%. In community-based settings, the effects of physician education also had a positive impact on mammography and clinical breast examination rates, which ranged from 6% to 14%. Using patient education to influence physician behavior was not effective in university settings, but had a modest impact in community trials. Generally, reminders were more cost-efficient than audit with feedback.
CONCLUSIONS: Physician-based interventions can be effective in increasing screening use. Interventions should emphasize community practices and practices caring for underserved and older populations.