ARE PATIENTS OF WOMEN PHYSICIANS SCREENED MORE AGGRESSIVELY - A PROSPECTIVE-STUDY OF PHYSICIAN GENDER AND SCREENING

被引:83
作者
KREUTER, MW
STRECHER, VJ
HARRIS, R
KOBRIN, SC
SKINNER, CS
机构
[1] the Department of Community Health, Division of Behavioral Science and Health Education, School of Public Health, Saint Louis University, St. Louis, Missouri
[2] the Health Communications Research Laboratory, Department of Health Behavior and Health Education, School of Public Health
[3] the Department of Medicine, Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
[4] the Division of Radiology Research, Malinckrodt Institute of Radiology, Washington University Medical School (CSS), St. Louis, Missouri
关键词
PREVENTIVE MEDICINE; MASS SCREENING; FAMILY PRACTICE; PHYSICIAN GENDER; PAP TESTING; MAMMOGRAPHY; CHOLESTEROL TESTING;
D O I
10.1007/BF02599664
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
OBJECTIVE: To determine the effects of physician gender on rates of Pap testing, mammography, and cholesterol testing when identifying and adjusting for demographic, psychosocial, and other patient variables known to influence screening rates. DESIGN: A prospective design with baseline and six-month follow-up assessments of patients' screening status. SETTING: Twelve community-based group family practice medicine offices in North Carolina. PARTICIPANTS: 1,850 adult patients, aged 18-75 years (six-month response rate, 83%), each of whom identified one of 37 physicians as being his or her regular care provider. MAIN RESULTS: Where screening was indicated at baseline, the patients of the women physicians were 47% more likely to get a Pap test [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.05, 2.04] and 56% more likely to get a cholesterol test (OR = 1.56, 95% CI = 1.08, 2.24) during the study period than were the patients of the men physicians. For mammography, the younger patients (aged 35-39 years) of the women physicians were screened at a much higher rate than were the younger patients of the men physicians (OR = 2.69, 95% CI = 0.98, 7.34); however, at older ages, the patients of the women and the men physicians had similar rates of screening. CONCLUSIONS: In general, the patients of the women physicians were screened at a higher rate than were the patients of the men physicians, even after adjusting for important patient variables. These findings were not limited to gender-specific screening activities (e.g., Pap testing), as in some previous studies. However, the patients of the women physicians were aggressively screened for breast cancer at the youngest ages, where there is little evidence of benefit from mammography. Larger studies are needed to determine whether this pattern of effects reflects a broader phenomenon in primary care.
引用
收藏
页码:119 / 125
页数:7
相关论文
共 34 条
[1]  
Hayward R.A., Shapiro M.F., Freeman H.E., Corey C.R., Who gets screened for cervical and breast cancer? Results from a new national survey, Arch Intern Med, 148, pp. 1177-81, (1988)
[2]  
Use of mammography-United States, 1990, MMWR, 39, pp. 621-9, (1990)
[3]  
Makuc D.M., Freid V.M., Kleinman J.C., National trends in the use of preventive health care by women, Am J Public Health, 79, pp. 21-6, (1989)
[4]  
Harlan L.C., Bernstein A.B., Kessler L.G., Cervical cancer screening: who is not screened and why?, Am J Public Health, 81, pp. 885-90, (1991)
[5]  
Lewis C.E., Disease prevention and health promotion practices of primary care practices in the United States, Am J Prev Med, 4, pp. 9-16, (1986)
[6]  
Woolhandler S., Himmelstein D.U., Reverse targeting of preventive care due to lack of health insurance, JAMA, 259, pp. 2872-4, (1988)
[7]  
The N.C.I., Breast Cancer Screening Consortium. Screening mammography: a missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Survey studies, JAMA, 264, pp. 54-8, (1990)
[8]  
Vogel V.G., Graves D.S., Vernon S.W., Lord J.A., Winn R.J., Peters G.N., Mammographic screening of women with increased risk of breast cancer, Cancer, 66, pp. 1613-20, (1990)
[9]  
Rakowski W., Jube C.E., Marcus B.H., Prochaska J.O., Velicer W.F., Abra D.B., Assessing elements of women’s decisions about mammography, Health Psychol, 11, pp. 111-8, (1992)
[10]  
Rakowski W., Fulton J.P., Feldman J.P., Women’s decision making about mammography: a replication of the relationship between stages of adoption and decisional balance, Health Psychol, 12, pp. 209-14, (1993)