Use of patient reminder letters to promote cancer screening services in women: A population-based study in Wisconsin.

BACKGROUND: Patient reminder letters are an effective method of promoting cancer screening services in women; however, information on their actual use in a population setting is lacking. METHODS: Data were obtained from a population-based, random digit dial telephone survey of 896 adult women living in Wisconsin. Respondents were asked if they had received a reminder letter for Pap or mammography screening within the past year. RESULTS: Among women aged >/=18 years, 12.9% (95% confidence interval [95% CI] = 10.1-15. 6) received a Pap test reminder within the past year, while 13.0% (95% CI = 9.3-16.7) of women aged >/=40 years received a mammography reminder. Women without health care coverage were unlikely to receive either type of reminder. Current compliance with screening recommendations was greater among those women who received a reminder letter for Pap tests (94.3 versus 78.1%, P < 0.0001) and for mammography (81.7 versus 59.4%, P < 0.001). In contrast to the infrequent use of cancer screening reminders, 54.2% (95% CI = 50. 1-58.3) and 72.7% (95% CI = 67.6-77.8) of women reported receiving a reminder letter from their dentist or veterinarian, respectively. CONCLUSIONS: Reminder letters for cancer screening services were rarely utilized in this study population. Receipt of a reminder letter was associated with greater compliance with current screening recommendations.     

Promoting mammography use through progressive interventions: is it effective?

This study evaluated interventions implemented with women in a health maintenance organization who had not utilized their annual free mammogram referral 45 days (step 2) and 95 days (step 3) after its mailing. The step 2 evaluation compared mammography utilization for women randomly assigned to receive a brief reminder letter or no reminder: 42% of the reminder group vs 28% of the control group obtained mammograms. The step 3 evaluation compared utilization for women randomly assigned to receive a second reminder, a letter suggesting a preventive office visit, or telephone counseling: 29% of those who received telephone counseling, 14% of those who received a letter, and 12% of those who received a second reminder obtained mammograms.     

上海市黄浦区屈光筛查异常儿童青少年复诊依从性相关因素分析

  目的  了解屈光筛查异常儿童青少年复诊率和复诊依从性相关影响因素, 为加强儿童青少年屈光发育档案管理与应用、提升近视防控效率和效果提供依据。  方法  采用整群抽样的方法, 选取上海市黄浦区3所小学和3所初中学校开展调查, 对所有学生建立屈光发育档案, 包括视力、非睫状肌麻痹电脑验光和眼轴长度等眼科检查, 并通过问卷调查收集复诊及相关因素信息, 采用多因素Logistic回归分析复诊的相关因素。  结果  筛查出疑似屈光异常的儿童青少年共2 104名, 通知需复诊儿童青少年实际复诊率60.4%, 其中指定定点医院复诊占58.8%。筛查前已有近视(OR=1.37, 95%CI=1.08~1.72)、筛查前已佩戴框架眼镜或角膜塑形镜(OR=2.05, 95%CI=1.62~2.59)、初筛后近视度数(OR_{-0.5 D以下}=2.08, 95%CI=1.48~2.92, OR_{-3.0~-0.5 D}=1.86, 95%CI=1.47~2.36)、初筛结果家长知晓(OR=2.92, 95%CI=1.89~4.50)、对复诊建议满意(OR=3.54, 95%CI=1.16~10.79)等5个因素为屈光筛查异常儿童青少年复诊依从性的影响因素(P值均 < 0.05)。  结论  屈光筛查异常需复诊儿童青少年实际复诊率有待提高。需进一步优化屈光档案医防融合信息化, 针对重点人群加强科普宣教、规范初筛屈光检查结果的专业解读, 并通过健康宣教提升家长知晓度、参与度和满意度, 实现屈光档案分级分类全流程闭环管理。     

Enhancing primary care HIV prevention: a comprehensive clinical intervention

CONTEXT: Human immunodeficiency virus (HIV) and sexually transmitted disease (STD) risk assessment and counseling are recommended for a large proportion of the population, yet measured rates of such counseling remain low. OBJECTIVE: Use a comprehensive intervention to improve and sustain rates of HIV/STD risk assessment and counseling by providers. DESIGN: Patient telephone survey using a one-group pre- and post-intervention design with measurements over a 62-week period. SETTING AND PARTICIPANTS: Patients (N=1042) from two outpatient clinics at a health maintenance organization (HMO) presenting for either of two types of index visit: symptomatic (n=210), or routine physical examination or birth control (n=832) visits. MAIN OUTCOME MEASURES: Telephone survey performed within 3 weeks of the index visit. Patients' recall of a general discussion of HIV/STDs and specific discussion of sexual behaviors/risk factors. RESULTS: The intervention was associated with increased patient recall of providers: discussing HIV/STD in general (OR 1.6; 95% CI, 1.12-2.22), asking about sexual behaviors/risk factors (OR 1.7; 95% CI, 1.2-2.6), discussing HIV prevention generally (OR 2.4; 95% CI, 1.4-4.0), and discussing personal risk reduction (OR 2.6; 95% CI, 1.6-4.3). Provision of written materials concerning HIV/STD also increased significantly (OR 2.8; 95% CI, 1.3-4.3). A clear-cut pattern of improved provider effort was seen, with the most pronounced improvements in high-risk patients. Results were stable over a 38-week follow-up period. CONCLUSION: A sustained improvement in HIV/STD risk assessment and counseling can be achieved in an outpatient HMO setting using a relatively non-intensive systematized intervention.     

Delivery of preventive health services for breast cancer control: a longitudinal view of a randomized controlled trial

OBJECTIVE: To develop a longitudinal model to characterize the delivery of mammography services using repeated observations of mammography referral rates during a randomized controlled trial (RCT) of physician mammography reminders. DATA SOURCES/STUDY SETTING: Administrative records of a health department and observational data on mammography appointment scheduling. STUDY DESIGN: The design was a longitudinal study of month-specific referral rates during a 1-year RCT. A retrospective case-control study was used to investigate differences between women with timely and delayed (or absent) mammography referral assessed at the end of the intervention year. DATA COLLECTION/EXTRACTION METHODS: Month-specific indicators for referrals and missed clinical opportunities, that is, months when clinic visitors were due for a mammogram and not referred, were constructed using administrative and observational data. FINDINGS: In the unadjusted analysis, the effectiveness of the reminder declined over time. However, in a multivariate analysis that controlled for the number of missed opportunities, the effectiveness was constant over time. On a monthly basis, physician reminders were significantly associated with higher referral rates among clinic visitors newly due for mammography (adjusted OR = 2.8, 95 percent CI = 1.3, 5.8) or who had one previously missed clinical opportunity (adjusted OR = 3.0, 95 percent CI = 1.6, 5.3) but were not for those with two or more missed clinical opportunities (adjusted OR = 1.2, 95 percent CI = 0.7, 2.3). Factors independently associated with delayed referral were age over 65, presence of more than one chronic illness, and the absence of a physician mammography reminder. CONCLUSIONS: Longitudinal models that examine rates of referral over time and include information about outcomes on previous visits can enhance our understanding of how intervention strategies work in practice.     

Referral and delivery outcomes in Kivu,Democratic Republic of Congo

BACKGROUND: The process of referral between the first and the second level of the health system in the Democratic Republic of Congo is poorly understood. This report intends to study the association between the referral and the hospital perinatal outcomes. METHODS: Delivery outcomes in a retrospective cohort of 1162 women admitted between June 95 and May 96, in two referral hospitals in Kivu were analyzed according to the referral status and the women's characteristics. RESULTS: Forty-three percent (n=492)of women admitted, corresponding to 2.3% of expected pregnant women, were referred. Referred women had higher risks of obstetrical complications (OR=2.0; CI95%: 1.3-3.1) and intervention (OR=1.5; CI95%: 1.0-2.3) and similar risks of low birth weight and perinatal mortality. Women with complications during the antenatal period had a double risk of intervention and perinatal mortality. The risk of obstetrical intervention was lower when women had attended 2 visits (OR=0.5; CI95%: 0.3-0.8); the risk of low birth weight was lowest only for mothers who had attended one visit (OR=0.5; CI95%: 0.3-0.9). Distance > or =90 minutes walking from home to hospital raised the risk of obstetrical complication (OR=1.7; CI95%: 1.1-2.5), the risk of obstetrical intervention (OR=1.5; CI95%: 1.0-2.1), and the risk of perinatal mortality (OR=1.6; CI95%: 1.0-2.7). Late admission raised the risk of perinatal mortality (OR=1.8; CI95%: 1.2-2.9) and lowered the risk of obstetrical complication (OR=0.7; CI95%: 0.5-1.0). Part payment of care was associated with higher risks of low birth weight (OR=1.9; CI95%: 1.3-2.9), perinatal mortality (OR=2.2; CI95%: 1.4-3.5) and obstetrical intervention (OR=2.4; CI95%: 1.7-3.4). CONCLUSION: These results suggest a deficit of referred cases considering that 15% of pregnant women in the area covered by the referral hospitals should have been referred. They confirm the negative influence of economic and geographic constraints on the delivery outcomes. They point out the relevance of making reorganization of the referral system a priority.     

Provision of health counseling in office-based practices and hospital outpatient clinics

OBJECTIVE: To compare the rates of health counseling provided during primary care visits in two different types of ambulatory care settings. METHODS: Secondary analysis of the 2000 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). RESULTS: Of the estimated 722 million adult ambulatory care visits during 2000, 90.8% were made to office-based physician practice settings and 9.2% to hospital-based outpatient departments. Consistent with previous reports, the demographic profile of patients who seek primary care in hospital outpatient departments differs from those seen in office-based practices. Provision of health counseling for exercise [OR = 1.4; 95% confidence intervals (CI): 1-1.8], diet (OR = 1.6; 95% CI: 1.2-2.3), breast self-exam (OR = 2; 95% CI: 1.1-3.6) and stress management (OR = 1.7; 95% CI: 1-2.7) during patient visits was more likely to be reported in the office-based practices than in hospital outpatient clinics. The visit-based rates of health counseling for HIV/STD prevention, tobacco use, mental health or injury prevention were low in both settings. CONCLUSIONS: There is opportunity to improve rates of preventive counseling in primary care settings and to reduce disparities that exist. Identifying the reasons for these disparities and effective interventions will be important steps in providing equitable care in the area of preventive health counseling.     

Recruitment to mammography screening: a randomised trial and meta-analysis of invitation letters and telephone calls

OBJECTIVES: To determine the effectiveness of three recruitment strategies to encourage women to attend for an initial mammography screen, and to compare results with similar service studies. Interventions were: (1) an invitation letter; (2) two invitation letters; and (3) an invitation letter plus a follow-up telephone call. METHODS: All women aged 50-54 years in two BreastScreen New South Wales (BSNSW) Screening and Assessment Service catchment areas (n=3,144) were recruited from the Australian Electoral Roll and randomised to the four groups. Response rates for each intervention were compared relative to standard practice (one invitation letter) at 12-weeks follow-up. Marginal cost-effectiveness for each condition was calculated. Other similar randomised trials were also meta-analysed. RESULTS: The screening rate for two letters was 8.5% (OR=1.61, 95% CI 1.08-2.40) and 7.8% (OR=1.46, 95% CI 0.97-2.18) for one letter plus a telephone call, compared with 5.5% for standard practice (one letter) (OR=1.00). The response rate in the one letter plus a phone call group was 13.3% (OR=2.65, 95% CI 1.76-4.00) for women where a phone number was located. CONCLUSION: Initial screening rates after a 12-week follow-up were significantly higher in the women receiving a second invitation letter, compared with standard practice (one letter). Marginal cost-effectiveness favoured the two-letter approach. IMPLICATIONS: A follow-up invitation letter is more cost-effective than one invitation letter plus a follow-up telephone call in the BSNSW program. However, an invitation letter plus follow-up phone call is more cost-effective in recruiting women to BSNSW only if a phone number is located.     

The comparison of health behaviors between widowed women and married women in jeollanamdo province, Korea

OBJECTIVES: To compare the health behaviors of widowed women with those of currently married women. METHODS: We randomly sampled the subjects from the Jeollanamdo Resident Registration Data and we then selected 2,331 widowed women and 4,775 married women. Well-trained examiners measured the height, weight, blood pressure and abdomen circumference, and the women were interviewed with using a questionnaire. Logistic regression analysis was used to estimate the odds ratios(OR) of the two groups. RESULTS: The smoking rate (OR=2.46; 95% confidence interval [CI]1.65, 3.66) was significantly higher for the widowed women. On the contrary, the awareness rate of a smoking cessation campaign (OR=0.80; 95% CI=0.70, 0.92), a quit tobacco telephone line (OR=0.73; 95% CI=0.61, 0.88) and a quit smoking clinic (OR=0.74; 95% CI=0.62, 0.89) were lower for the widowed women. The rate of receiving a health exam (OR=0.80; 95% CI=0.70, 0.91), the rate of undergoing gastric cancer screening (OR=0.77; 95% CI=0.68, 0.88), breast cancer screening (OR=0.79; 95% CI=0.69, 0.89), cervix cancer screening in the last 2 years (OR=0.81; 95% CI=0.71, 0.92), colon cancer screening in the last 5 years (OR=0.74; 95% CI=0.63, 0.87) were significantly lower for the widowed women. CONCLUSIONS: This study revealed that the health behaviors are significantly different between the widowed women and the married women. To improve the health behaviors of the widowed women, further study and research that will investigate the socioeconomic and environmental factors that affect the health behaviors of widowed women will be needed.     

Comparing Participants and Nonparticipants in a Smoking Cessation Trial: Selection Factors Associated With General Practitioner Recruitment Activity

We studied the relationship between smokers’ sociodemographic characteristics, their smoking habit, health status, and the probability of their having been approached for recruitment in the smoking cessation trial performed in Turin, Italy, with the aim of gathering information on the role of selection criteria adopted by general practitioners (GPs) in offering anti-smoking counseling. The 965 smokers who were offered participation in the trial were matched to a sample of eligible smokers (n = 277), selected from the rosters of the 42 GPs collaborating in the trial, who had not been invited to participate. The probability of being offered enrollment, estimated through a multiple conditional logistic regression model, assuming the GP as the matching variable, was significantly increased for intermediate (10–19 cigarettes per day: odds ratio [OR] = 4.13; 95% confidence interval [CI]: 2.63–6.47) and heavy (20 cigarettes per day or more: OR = 10.12; 95% CI: 6.51–15.75) smokers, for smokers diagnosed with chronic cardiovascular (OR = 2.06; 95% CI: 1.19–3.58), or respiratory (OR = 2.50; 95% CI: 1.40–4.48) diseases, and for smokers mentioning an intermediate number (2–4) of past quit attempts (OR = 3.70; 95% CI: 2.18–6.28). General Practitioners focused their recruitment activity on higer-risk smokers or smokers who had tried to quit, to offer more clues for intervention. Assessing the potential public health benefit of preventive interventions requires a more systematic evaluation of the generalizability of the reported findings.     

Delivering Preventive Health Services for Breast Cancer Control: A Longitudinal View of a Randomized Controlled Trial

Objective. To develop a longitudinal model to characterize the delivery of mammography services using repeated observations of mammography referral rates during a randomized controlled trial (RCT) of physician mammography reminders. Data Sources/Study Setting . Administrative records of a health department and observational data on mammography appointment scheduling. Study Design. The design was a longitudinal study of month‐specific referral rates during a 1‐year RCT. A retrospective case‐control study was used to investigate differences between women with timely and delayed (or absent) mammography referral assessed at the end of the intervention year. Data Collection/Extraction Methods. Month‐specific indicators for referrals and missed clinical opportunities, that is, months when clinic visitors were due for a mammogram and not referred, were constructed using administrative and observational data. Findings. In the unadjusted analysis, the effectiveness of the reminder declined over time. However, in a multivariate analysis that controlled for the number of missed opportunities, the effectiveness was constant over time. On a monthly basis, physician reminders were significantly associated with higher referral rates among clinic visitors newly due for mammography (adjusted OR=2.8, 95 percent CI=1.3, 5.8) or who had one previously missed clinical opportunity (adjusted OR=3.0, 95 percent CI=1.6, 5.3) but were not for those with two or more missed clinical opportunities (adjusted OR=1.2, 95 percent CI=0.7, 2.3). Factors independently associated with delayed referral were age over 65, presence of more than one chronic illness, and the absence of a physician mammography reminder. Conclusions. Longitudinal models that examine rates of referral over time and include information about outcomes on previous visits can enhance our understanding of how intervention strategies work in practice.     

HIV infection and pregnancy status among adults attending voluntary counseling and testing in 2 developing countries

OBJECTIVES: This study investigated the impact of HIV voluntary counseling and testing (VCT) on reproduction planning among 1634 adults in 2 sub-Saharan countries. METHODS: Data were obtained from a multisite randomized controlled trial. RESULTS: At 6 months post-VCT, the women more likely to be pregnant were younger (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.0, 6.5), not using contraceptives (OR = 0.1; 95% CI = 0.1, 0.3), and HIV infected (OR = 3.0; 95% CI = 1.3, 7.0). An interaction emerged linking pregnancy intention at baseline and HIV serostatus with pregnancy at follow-up (OR = 0.1; 95% CI =.0, 0.4) Partner pregnancy rates did not differ by HIV serostatus among men. CONCLUSIONS: HIV diagnosis may influence reproduction planning for women but not for men.     

Preventive home visits to older home‐dwelling people in Denmark: are invitational procedures of importance?

Since 1998 all municipalities in Denmark have been required by law to offer two annual preventive home visits to all home‐dwelling citizens aged 75 or over. The influence of invitational procedures on acceptance rates has not been investigated. The aim of this study was to describe and investigate whether different invitational procedures were associated with first preventive home visit acceptance rates. The study was based on secondary analyses of data from the Danish Intervention Study on Preventive Home Visits. Data were collected from 1998 to 2002. Of the 4060 participants in the main study, 3245 reported receiving an offer for an identifiable preventive home visit, of whom 2399 (73.9%) provided complete data for the main analyses in the present study. Invitational procedures were categorised as: (1) a letter with a proposed date and time for the visit, (2) a visitor telephone call, and (3) a letter with encouragement to phone the visitor for appointment (letter without a proposed date). Covariates included sex, age, experience with preventive interventions, functional ability, self rated health, social relations and psychosocial characteristics. Statistical analyses included chi‐square tests, and bi‐ and multivariable logistic regression analyses. Different invitational procedures were associated with first preventive home visit acceptance rates. Significantly more men (75.1%) than women (62.8%) declined the first preventive home visit regardless of the invitational procedure. Compared to ‘letter with a proposed date’, men had an odds ratio of 1.78 (95% CI: 1.16–2.74) for declining visits when ‘telephone call’ was used and an odds ratio 2.81 (95% CI: 1.79–4.40) when ‘letter without a proposed date’ was used as the invitational procedure. In women the odds ratios were 1.23 (95% CI: 0.91–1.68) and 1.87 (95% CI: 1.37–2.55), respectively.     

Effect of an administrative intervention on rates of screening for domestic violence in an urban emergency department

OBJECTIVES: This study measured the effects of an administrative intervention on health care provider compliance with universal domestic violence screening protocols. METHODS: We used a simple, interrupted-time-series design in a stratified random sample of female emergency department patients 18 years or older (n = 1638 preintervention, n = 1617 postintervention). The intervention was a 4-tiered hospital-approved disciplinary action, and the primary outcome was screening compliance. RESULTS: Preintervention and postintervention screening rates were 29.5% and 72.8%, respectively. Before the intervention, screening was worse on the night shift (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.31, 0.68) and with psychiatric patients (OR = 0.34, 95% CI = 0.14, 0.85); after the intervention, no previous screening barriers remained significant. CONCLUSIONS: An administrative intervention significantly enhanced compliance with universal domestic violence screening.     

Predictors of returning for second round screening at a population based mammographic screening programme in Melbourne, Australia.

OBJECTIVE: To examine factors associated with returning for second round mammography screening. SETTING: This was a population based mammographic screening programme in Melbourne, Australia. DESIGN: A cohort design was used whereby 668 women were interviewed before the screening programme began and attendance for both first and second round screening was ascertained from programme records. The cohort sample was drawn from two regions of a defined area (close to and distant from the screening centre). MAIN RESULTS: Of the 315 women who attended for first round screening, 75% from the proximal sample and 70% from the distal sample returned for second round screening. Attendance at the second round was predicted by the following: the method of recruitment for first round screening, with women who required a letter of invitation and a reminder being less likely to reattend than those who initially attended in response to a community campaign (OR = 0.34; CI 0.19, 0.61); mammographic history before the initial screen, with women who reported previous diagnostic mammography being more likely to reattend than those who did not (OR = 2.97; CI 1.01, 8.9); stated intention of attending for the initial screen, with those with weakest intention of attending for their first round being less likely to attend for second round (OR = 0.44; CI 0.23, 0.85); and increasing scores on a scale that measured preventive orientation to health (OR = 1.24; CI 1.02, 1.50). CONCLUSION: Our findings corroborate other findings of reduced long term attendance for screening from people who are "reluctant participants" initially.     

Colorectal cancer screening participation: comparisons with mammography and prostate-specific antigen screening

OBJECTIVES: The relation of personal characteristics, health and lifestyle behaviors, and cancer screening practices to current colorectal cancer (CRC) screening was assessed and compared with those factors' relation to current mammography screening in women and prostate-specific antigen (PSA) screening in men. METHODS: A cross-sectional random-digit-dialed telephone survey of 954 Massachusetts residents aged 50 and older was conducted. RESULTS: The overall prevalence of current CRC screening was 55.3%. Logistic regression results indicated that family history of CRC (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.02, 3.86), receiving a regular medical checkup (OR = 3.07; 95% CI = 2.00, 4.71), current screening by mammography in women and PSA in men (OR = 4.40; 95% CI = 2.94, 6.58), and vitamin supplement use (OR = 1.87; 95% CI = 1.27, 2.77) were significant predictors of CRC screening. CONCLUSIONS: Health and lifestyle behaviors were related to increased current CRC, mammography, and PSA screening. Personal factors independently related to CRC screening were not consistent with those related to mammography and PSA screening. This lack of consistency may reflect different stages of adoption of each type of screening by clinicians and the public.     

Pediatricians' own weight: self-perception, misclassification, and ease of counseling

OBJECTIVES: Pediatricians underdiagnose overweight and feel ineffective at counseling. Given the relationship between physicians' health and health habits and counseling behaviors, we sought to determine the 1) percentage of pediatricians who are overweight; 2) accuracy of pediatricians' own weight status classification; and 3) relationship between weight self-perception and perceived ease of obesity counseling. RESEARCH METHODS AND PROCEDURES: This study was a cross-sectional, mail survey of North Carolina pediatricians that queried about their weight status and ease of counseling. Accuracy of pediatricians' self-classification of weight status was compared with BMIs derived from self-reported height and weight. Using logistic regression, controlling for potential confounding variables, we examined the association between weight perception and ease of counseling. RESULTS: The unadjusted response rate was 62%, and the adjusted response rate was 71% (n = 355). Nearly one-half (49%) of overweight pediatricians did not identify themselves as such. Men had greater adjusted odds of misclassifying overweight than women [odds ratio (OR), 3.61; 95% confidence interval (CI) = 1.81, 7.21]. Self-classified "thin" pediatricians had nearly six times the odds of reporting more counseling difficulty as a result of their weight than "average" weight pediatricians (OR = 5.69; 95% CI = 2.30, 14.1), and self-identified "overweight" pediatricians reported nearly four times as great counseling difficulty as "average" weight physicians (OR = 3.84; 95% CI = 1.11, 13.3), after adjustment for self-reported BMI weight status and other potential confounders. DISCUSSION: The roles that physician weight misclassification and self-perception potentially play in influencing rates of obesity counseling warrant further research.     

Knowledge, Attitudes, and Interest in Breast-Ovarian Cancer Gene Testing: A Survey of a Large African-American Kindred with a BRCA1 Mutation

BACKGROUND: This study assessed counseling and testing needs from the perspective of adult members of a large African-American kindred with a BRCA1 mutation. METHODS: Interviews were conducted with 95 male and female kindred members to elicit information on sociodemographics, attitudes toward health care providers, breast cancer screening behaviors, and religious/spiritual beliefs, as well as to evaluate psychological distress, beliefs, knowledge, and attitudes related to genetic testing. RESULTS: Knowledge about breast and ovarian cancer genetics was limited. Adherence to screening recommendations was low among females with no personal breast or ovarian cancer history. The majority (67%) wished to discuss risk factors with a health care provider. Most participants (82%) indicated that they would have a genetic test if it were available. Significant predictors of intent to undergo testing were having at least one first-degree relative with breast and/or ovarian cancer (OR = 5.1; 95% CI = 1.2-20.9) and perceived risk of being a gene carrier > or =50% (OR = 64.3; 95% CI = 5.1-803.9) or reporting that they did not know their risk of being a gene carrier (OR = 10.9; 95% CI = 2.1-57.7). Cited barriers to testing included cost and availability. CONCLUSION: There is a high interest level in genetic testing despite limited knowledge about cancer genetics among these high-risk African Americans. Our study provides information for designing a genetic education and counseling intervention for this and similar families.     

分级诊疗背景下徐州市慢性病患者基层就诊现状及影响因素研究

目的 了解徐州市慢性病患者基层就诊现状和影响因素,为加强慢病管理、促进合理就医提供建议。方法 采用分层随机抽样方法,抽取徐州市3个县区的600名慢性病患者进行问卷调查。利用SPSS 25.0统计软件进行统计描述、〖XC小五号.EPS;P〗检验和logistic回归分析。结果 徐州市慢性病患者就医率为73.22%,基层首诊率为54.22%。Logistic回归结果显示,有基层就医经历（OR=2.427,95%CI:1.539~3.829;OR=6.263,95%CI:3.215~12.201）、知晓分级诊疗制度（OR=2.093,95%CI:1.340~3.269;OR=3.900,95%CI:2.262~6.723）的慢性病患者就医率和基层首诊率均高;城市（OR=1.835,95%CI:1.171~2.876）、年医疗费用高（OR3000~=5.301,95%CI:1.906~14.739;OR≥5000=3.088,95%CI:1.346~7.089）、有健康体检者（OR=1.956,95%CI:1.268~3.015）就医率高;文化程度低（OR高中/中专=2.433,95%CI:1.053~5.623;OR大专及以上=0.210,95%CI:0.048~0.914）、月均收入低（OR1000~=0.442,95%CI:0.236~0.829;OR3000~=0.075,95%CI:0.029~0.195）、年医疗费用低（OR1000~=0.108,95%CI: 0.033~0.349;OR3000~=0.108,95%CI:0.031~0.372;OR≥5000=0.093,95%CI:0.028~0.310）、距二/三级医疗机构远者（OR=2.759,95%CI:1.565~4.865）基层首诊率高。结论 徐州市慢性病患者就医率和基层首诊率较低,建议从健康管理、基层建设、流程简化、制度引导等方面,促进慢性病患者合理就医,保障慢性病患者健康。