Breast screening practices among primary physicians: reality and potential

Increased use of regular screening mammograms and clinical breast examinations (CBE) among women aged 40 years and more could have a dramatic impact on mortality from breast cancer, but patient and physician barriers to mammography impede its acceptance. We conducted a survey of 300 primary care physicians to assess their knowledge, attitudes, beliefs, and breast screening practices. Our results show that only 71 percent of the respondents ordered mammograms for all women aged 50 to 75 years, which is the recommendation by the National Cancer Institute and American Cancer Society. Approximately 46 percent of respondents performed CBE on all women patients aged 50 to 75 years. Inadequate patient insurance coverage, equivocal radiology reports, patient reluctance or worry, and patient embarrassment all appear to be barriers to physicians' utilization of breast screening.     

Hepatitis B prevention: practices and attitudes of physicians and dentists

A survey of community-based physicians and dentists from the Washington, D.C., metropolitan area was conducted to assess the practices and attitudes of these health professionals relative to hepatitis B prevention. Mail questionnaires were sent to 200 physicians and 200 dentists. An overall response rate of 50 percent was obtained with one follow-up to all nonrespondents. The preventive practices adopted by the physicians were found to differ significantly from those of the dentists, including risk factors, history taking, using gloves and/or masks, and routinely screening for serologic markers. The physicians were significantly more likely than the dentists to be unwilling to take a safe, effective, hepatitis vaccine (p less than .01). Concerns about long-term safety and side effects were the most frequently mentioned reasons for this attitude. Though most survey respondents believed that if they were to become a hepatitis B chronic carrier, it would be better to know about it. Twenty six percent of the physicians and 14 percent of the dentists believed that not knowing about being a chronic carrier would be protective in a legal action against them. A majority of all of the health professionals surveyed felt that knowing their carrier status could jeopardize their career.     

Cancer screening practices among cancer survivors

BACKGROUND: Cancer survivors are more vulnerable to future cancers than individuals without cancer. As such, it is important to understand whether survivors are engaging in cancer screenings. METHODS: The screening practices reported in response to the 2000 Health Interview Survey of 2151 individuals with cancer were examined and compared to those of 30,195 individuals without cancer. RESULTS: The proportion of cancer survivors obtaining screenings ranged from 21% to 77%. Compared to individuals without cancer, women with cancer were more likely to have had a mammogram (odds ratio [OR]=1.8, 95% CI=1.5-2.1), a clinical breast exam (OR=2.2, 95% CI=1.9-2.5), and/or a Papanicolaou test (OR=1.3, 95% CI=1.1-1.5) in the recommended timeframe. Similarly, men with cancer were more likely than men without cancer to have had a prostate-specific antigen test performed (OR=2.5, 95% CI=2.0-3.0). All cancer survivors were more likely than individuals without a cancer diagnosis to have had a total body skin exam (OR=4.0, 95% CI=3.5-4.6), a fecal occult blood test (OR=1.4, 95% CI=1.2-1.6), and/or a colorectal exam (OR=2.2, 95% CI=1.9-2.5). Similar results were obtained when individuals diagnosed with the cancer for which the screen was designed to detect were excluded. CONCLUSIONS: The results demonstrate that cancer survivors have higher screening rates than individuals without a cancer diagnosis. Despite this, the proportion of survivors obtaining screenings varies considerably by the type of screen. An understanding of the impact of cancer screening in cancer survivors, as well as the reasons for and against obtaining cancer screenings, is necessary.     

Colorectal cancer screening: practices and opinions of primary care physicians

BACKGROUND: The Canadian Task Force on Preventive Health Care (CTFPHC), in 2001, concluded that there is good evidence to include annual or biennial fecal occult blood testing (FOBT) and fair evidence to include flexible sigmoidoscopy in the periodic health examination of asymptomatic adults more than 50 years of age. METHODS: Mailed survey of Alberta primary care physicians to determine current colorectal cancer (CRC) screening practices, familiarity with the new guideline, and opinions about, and barriers to, screening average-risk patients. RESULTS: Response rate was 58.0% (n = 965). Less than half (41.9%) were familiar with the new Canadian guideline. The majority (74.7%) recommended that asymptomatic patients undergo screening; however, only 35.6% offered screening to at least 75% of average-risk patients. Few (9.4%) rated fecal occult blood as an "excellent or very good" screening test. Most (64.1%) physicians would choose colonoscopy if they themselves were to undergo screening. Concerns were raised about cost-effectiveness, inconsistencies of current recommendations, and resources. CONCLUSION: Although supportive of colorectal cancer screening of average-risk patients, few physicians recommend screening for the majority of their patients. Clarification of inconsistencies between guidelines, resource issues, and the availability of efficacious screening tests is required for wider acceptance of the new Canadian guideline.     

Alcohol screening practices of primary care physicians in eastern North Carolina

In our study, 616 primary care physicians of eastern North Carolina were surveyed for screening practices for detection of alcoholism in their patient population. We defined primary care as Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics and Psychiatry. We defined eastern North Carolina as the 29 counties that Pitt County Memorial Hospital serves. In our survey we found that eastern North Carolina is medically underserved as well as having less resources for referral and consultation. In response to the questionnaire, we found that most physicians agreed on some numerical value for drinks per day, social drinks, and drinks per week while pregnant. Values for drinks per week and weekend binges generally reflected significant tolerance for heavy drinking behavior. We also found that physicians of the same specialty commonly agreed on answers but when compared to other specialties they differed. Physicians preferred personal and clinical screening methods to questionnaires such as CAGE. Most physicians did not prescribe Antabuse but did suggest to their patients to cut down on drinking. Physicians felt that their patients needed more education and support from the community as well as intervention at an early age. We conclude that physicians should receive more education concerning alcoholism and substance abuse.     

Cancer prevention and screening behaviors in lesbians

The incidence of cancer diagnosis has increased in the United States highlighting the need for astute cancer prevention and screening behaviors. Previous literature has suggested that lesbians may not follow the American Cancer Society's (ACS) guidelines regarding prevention and screening for cancer due to disparity in access to care and increased use of alcohol and tobacco. The purpose of this study was to examine the cancer prevention and screening behaviors of lesbians using the ACS guidelines as the standards for comparison, and to determine factors that influence mammography screening. A 102-item self-report survey was distributed to lesbians nationwide using various methods including snowballing sampling techniques. The sample included 1139 self-identified lesbians from 44 states. In general, healthy lifestyle behaviors were followed. The majority of the women did not smoke, ate plenty of fruits and vegetables, ate protein sources low in fat and consumed alcohol at a moderate rate. However, safe sex practices were often not used by participants. Most women did have mammograms and Papanicolaou smears (PAP) as recommended; however, adherence to self-breast examination guidelines was not followed. Women who were older, had higher yearly incomes, did not smoke, performed regular self breast exams and had regular physical exams were most likely to have a mammogram. Over half of the women met American Cancer Society guidelines for prevention and screening for breast and cervical cancer. However, strategies are needed to increase compliance with these guidelines in order to improve cancer health outcomes.     

Tuberculosis prevention practices and perspectives of physicians in DeKalb County,GA.

Knowing the reasons some physicians do not adhere to the disease prevention and treatment recommendations of expert committees can assist in the development of future recommendations more likely to be adopted by physicians. The authors describe the attitudes and practices of physicians relative to tuberculosis prevention in DeKalb County, GA. Tuberculosis is an important problem in the county, which includes part of the City of Atlanta, as well as suburban areas. Questionnaires for anonymous reply were mailed to 1,621 physicians in the county in 1991, and 848 (53 percent) were completed and returned. The final sample was 793 physicians, who were grouped into 5 specialty areas. Primary care physicians were the group most commonly involved in specific tuberculosis screening and prevention activities. Medical and pediatric specialists, surgeons, obstetricians-gynecologists, and other physicians were significantly less likely to be involved in such activities. Given that primary care physicians constitute a decreasing proportion of physicians in the United States, the findings suggest the importance of ensuring that future strategies for tuberculosis prevention take into account the increasingly specialized nature of the medical practice environment.     

Spouse/partner violence education as a predictor of screening practices among physicians

INTRODUCTION: Spouse/partner violence is a major public health problem that affects 3 to 6 million women per year. Many studies show that the majority of health care practitioners do not detect or respond to cases of spouse/partner violence in their practice. Research suggests that there are potential barriers to reporting or detecting this problem. A barrier often cited is lack of proper education or training regarding spouse/partner violence. The objective of this study was to determine if physicians who received spouse/partner violence education at various stages of their careers were more likely to screen patients for spouse/partner violence. METHODS: A survey was developed and administered to family physicians and obstetricians/gynecologists in Virginia. The data were analyzed to determine screening practice and spouse/partner violence education among respondents. Four different educational opportunities were analyzed to determine potential determinants of screening. RESULTS: All respondents who had spouse/partner violence education were more likely to screen every patient than those who were lacking this education. Receiving lectures during residency training was found to be a significant predictor of screening every patient for spouse/partner violence among respondents. DISCUSSION: Screening every patient for exposure to spouse/partner violence is the ideal situation. This study indicates that education about spouse/partner violence has a significant impact on screening tendencies if provided during a physician's residency program.     

Lung cancer screening practices of primary care physicians: results from a national survey

PURPOSE

Although current practice guidelines do not recommend screening asymptomatic patients for lung cancer, physicians may still order lung cancer screening tests. No recent national survey of health care professionals has focused on lung cancer screening. In this study, we examined the lung cancer screening practices of US primary care physicians and characteristics of those who order lung cancer screening tests.

METHODS

We conducted a nationally representative survey of practicing primary care physicians in 2006–2007. Mailed questionnaires assessed the physicians’ knowledge of lung cancer screening guidelines, beliefs about the effectiveness of screening tests, and ordering of screening chest radiograph, low-dose spiral computed tomography, or sputum cytology in the past 12 months. Clinical vignettes were used to assess the physicians’ intentions to screen asymptomatic 50-year-old patients with varying smoking histories for lung cancer.

RESULTS

A total of 962 family physicians, general practitioners, and general internists completed questionnaires (cooperation rate = 76.8%). Overall, 38% had ordered no lung cancer screening tests; 55% had ordered chest radiograph, 22% low-dose spiral computed tomography, and less than 5% sputum cytology. In multivariate modeling, physicians were more likely to have ordered lung cancer screening tests if they believed that expert groups recommend lung cancer screening or that screening tests are effective; if they would recommend screening for asymptomatic patients, including patients without substantial smoking exposure; and if their patients had asked them about screening.

CONCLUSIONS

Primary care physicians in the United States frequently order lung cancer screening tests for asymptomatic patients, even though expert groups do not recommend it. Primary care physicians and patients need more information about lung cancer screening’s evidence base, guidelines, potential harms, and costs to avert inappropriate ordering.     

Contraceptive practices of female physicians

To evaluate a potential bias between methods of birth control used and prescribed by physicians, we surveyed sexually active female physicians in regards to their own methods of birth control. When the contraceptive practices of female physicians are compared to those of the general population, no difference in use of various contraceptive methods is found. Among female obstetrician-gynecologists, however, the intrauterine device continues to be a disproportionally popular method of contraception. It is concluded that no gender bias exists in prescribing patterns of contraceptives since contraceptive use in female physicians is identical to that of the general populations.     

Cancer screening by primary care physicians. Can we explain the differences?

BACKGROUND. Physicians perform cancer screening tests less often than recommended. METHODS. Forty primary care physicians were surveyed to assess their knowledge, attitudes, and experiences regarding cancer and cancer screening, and patients' medical records were reviewed to measure physicians' screening rates. RESULTS. Over 80% of physicians believed doctors should urge screening. On average, 23% of their patient visits were scheduled primarily for preventive care interventions. Screening performance scores expressed the percentage of compliance with the American Cancer Society's recommendations and demonstrated the low levels of compliance for six out of seven tests; however, there was substantial variance in performance among physicians. The best predictors of screening performance were (1) the percentage of visits scheduled primarily for prevention (mammography, and pelvic and breast examinations [P less than .05]); and (2) the number of medical journals read regularly (stool occult blood test [P less than .01], sigmoidoscopy [P less than .01], and Papanicolaou smear [P less than .02]). Also, female physicians performed more Papanicolaou smears (P less than .05) and scheduled more visits for preventive care (P less than .001). CONCLUSIONS. A small group of predictors explain large portions of the variance in cancer screening performance.     

Aids education practices among Massachusetts physicians

Physicians have a major role to play in the prevention of AIDS transmission. Promotion of health behaviors needs to be expanded beyond the traditional AIDS high risk populations; however, little information is available on the AIDS education practices of physicians. A survey of Massachusetts physicians in four specialty groups, Family Medicine Practitioners, Internists, Obstetricians/Gynecologists and Pediatricians, was conducted to determine the extent of their AIDS education practices. Three hundred and ninety one physicians returned the questionnaire for an overall response rate of 66%. Sixty three percent (63%) of the physicians surveyed educate patients they believe to be at least at moderate risk for AIDS transmission or exposure. However, neither physicians screening for patients' AIDS risk status nor the content of the AIDS education was uniform. Also, very few physicians have received specific training in AIDS education. A number of practice, patient, and physician characteristics were found to be related to educational practices. This study suggests that a more comprehensive screening of patients' participation in AIDS risk behaviors be conducted as part of medical history taking, and that more comprehensive education be provided to those patients determined to be at least at moderate risk for AIDS transmission or exposure.Ruth A. Carretta, M.P.H. is an Analyst with the Outside Health Resource Utilization Program, Harvard Community Health Plan, Boston, Mass. 02215; Thomas W. Mangione, Ph.D. is Associate Professor of Public Health, Boston University School of Public Health, Boston, MA 02118 and Senior Research Fellow, Center for Survey Research, University of Massachusetts — Boston, Boston, MA 02116; Presley F. Marson, M.D., M.P.H. is a student at the Boston University School of Public Health, Boston, MA 02118; S.S. Darmono, M.D., M.P.H. is a student at the Boston University School of Public Health, Boston, MA 02118. Requests for reprints should be addressed to: Thomas W. Mangione, Ph.D., Center for Survey Research, University of Massachusetts — Boston, 100 Arlington St. — Suite 210, Boston, MA 02116.This study was conducted as part of a course offered by the Boston University School of Public Health. This research was also supported in part from funds from the Boston University School of Public Health and the Center for Survey Research at the University of Massachusetts — Boston.We would like to acknowledge the contributions of Patricia M. Demers, R.N., M.S., M.P.H., Efstratios Demetriou, M.D., Elizabeth A. Harvey, Ph.D., Suzanne Moore, M.P.H., R.N.C., Ph.D. candidate, and Nancy Salitsky, R.N., M.P.H. for their assistance in the design of the questionnaire, data collection, input into the analysis, and editorial advice; Kathleen Butterfield, Jean F. Saint-Elme, M.D., M.P.H., and Anneke Suparwati, M.P.H. for their assistance in design of the questionnaire and data collection; and Carmen Arroyo for creating the data entry program and providing the data analysis runs.     

Determinants of breast cancer screening among inner-city Hispanic women in comparison with other inner-city women.

A telephone survey of a random sample of Rhode Island women ages 40 and older residing in minority low-income census tracts--census tracts in the lowest quartile of a variety of socioeconomic indicators in which at least 5 percent of the population was classified as Hispanic or non-Hispanic black--was conducted in 1991, focusing on breast cancer screening. Hispanic women were found to have about half the breast cancer screening rate (20 percent, according to current screening guidelines) of other respondents (37 percent). Determinants of screening were explored to suggest reasons for this difference. The Health Belief Model was used to identify and compare determinants of breast cancer screening (sociodemographics, health care utilization, perceived susceptibility to breast cancer, perceived seriousness of breast cancer, cues to screening such as a provider''s recommendation, and the perceived benefits and costs of screening) among Hispanics, non-Hispanic whites, and non-Hispanic blacks. Hispanics were younger, less educated, and had lower family incomes than other women residing in minority low-income census tracts, were less likely to receive medical care, to perceive themselves as susceptible to breast cancer, and to perceive breast cancer as curable. Logistic regression analyses revealed the importance of use of health care, cues for screening, and perceptions of mammography to explain the screening behavior of Hispanics and non-Hispanics alike. Access to medical care is a significant problem in the Rhode Island Hispanic community, related to recent immigration, undocumented immigration, and low income characteristics of its members.(ABSTRACT TRUNCATED AT 250 WORDS)     

Billing practices of North Carolina family physicians

BACKGROUND. This study describes billing practices of family physicians. Significant increases in the reimbursement for family physicians are expected from implementation of the resource-based relative value scale (RBRVS). However, the real impact of the RBRVS is unknown since little is known about how family physicians use the present reimbursement system to charge their patients. METHODS. A random sample of 270 North Carolina family physicians was surveyed, using standardized progress notes of five hypothetical patients. RESULTS. One hundred thirty-eight (51%) physicians responded; 107 (77.5%) were in private practice. Family physicians in private and nonprivate practices were similar in their Current Procedural Terminology (CPT) coding and level of service for each hypothetical case. Family physicians in smaller communities showed greater variation in CPT coding of visits than did family physicians in larger communities, and they were more likely to use CPT codes that indicated a lower level of visit. Rural family physicians demonstrated a significant inverse relationship between the CPT level of visit coded (ranging from "brief," with a CPT code of 90040, to "comprehensive," coded CPT 90080) and the amount they charged established patients for a "limited" visit (CPT 90050). CONCLUSIONS. These findings suggest that the lower income of rural physicians is due, in part, to billing at a lower CPT code, and thus charging less for comparable services, than urban physicians. The findings also lend further support to contentions that federal reimbursement reforms will have less impact on the incomes of rural physicians than originally expected.