Effect of continuing medical education and cost reduction on physician compliance with mammography screening guidelines

BACKGROUND. Primary care physicians perform breast cancer screening in women aged 50 years and older less frequently than recommended by national guidelines. METHODS. A multimethod continuing medical education (CME) intervention was tested in an attempt to increase breast cancer screening practices in a predominantly fee-for-service practice community in New York State. Preintervention and postintervention surveys of primary care physicians were conducted in 1988 and 1990, respectively. Project-initiated, low-cost mammography in one town and the unanticipated provision of free mammography services in another town under nonproject auspices permitted a comparison to be made between these towns and towns where mammography screening was provided at the prevailing fees to determine the impact that cost has on physicians' referral of women patients for mammography. RESULTS. Physicians practicing in the towns in which the CME intervention was provided showed a significant increase, consistent across specialty groups and greatest among family physicians, in the number of reported mammography referrals of asymptomatic women aged 50 to 75 years. Changes in the CME control town were smaller and not statistically significant for the sample size available. The increase in compliance was as large in the CME-intervention towns, one without (19%) and one with low-cost mammography (20%), as the increase in the town with free mammography alone (18%). There were no significant increases in reported performance of breast examination. CONCLUSIONS. A multimethod program of CME is a feasible approach to increasing community physician compliance with mammography screening guidelines, particularly among family physicians, and can enhance the impact of reduced cost or have at least the equivalent effect of free mammography services.