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Effectiveness of Academic Detailing on Breast Cancer Screening among Primary Care Physicians in an Underserved Community

Department of Epidemiology (SSG), Mailman School of Public Health
Department of Sociomedical Sciences (DG), Mailman School of Public Health
Department of Biostatistics (MD), Mailman School of Public Health
Teachers College Department of Health and Social Behavior (SSG), Columbia University, New York, NY
Department of Medicine (ARA, RL), College of Physicians and Surgeons, Columbia University, New York, NY
Herbert Irving Comprehensive Cancer Center (SSG, ARA, RL, MD, DG), College of Physicians and Surgeons, Columbia University, New York, NY
Harlem Hospital Center (ARA), New York, NY
Department of Biostatistics and Epidemiology (AT), University of Pennsylvania, School of Medicine, Philadelphia, PA

Correspondence: Corresponding author: Sherri Sheinfeld Gorin, PhD, Columbia University, 954, 525 West 120th Street, Mailbox 239, New York, NY 10027 (E-mail: ssg19{at}columbia.edu)

Background: Urban minority groups, such as those living in northern Manhattan and the South Bronx, are generally underserved with regard to breast cancer prevention and screening practices. Primary care physicians are critical for the recommendation of mammography and clinical breast examinations to their patients.

Design: Two medically underserved communities were matched and block randomized. The aim of the study was to assess the efficacy of academic detailing in increasing recommendations for breast cancer screening in community-based primary care physicians.

Setting/Participants: Ninety-four primary care community-based (ie, not hospital-based) physicians in northern Manhattan were compared with 74 physicians in the South Bronx who received no intervention.

Intervention: Intervention participants received multicomponent physician-directed education, academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer.

Main Outcome Measures: We administered interviews to ask about primary care physicians’ recommendation of mammography and clinical breast examination. They were also queried about their knowledge of major risk factors and perceived barriers to breast cancer screening. We conducted medical audits of 710 medical charts 2 years before and after the intervention.

Results: Using a mixed models linear analysis, we found a statistically significant intervention effect on the recommendation of mammography and clinical breast examination (according to medical audit) by female patients age 40 and over. Intervention group physicians correctly identified significantly more risk factors for breast cancer, and significantly fewer barriers to practice, than did comparison physicians.

Conclusions: We found some evidence of improvement in breast cancer screening practices due to academic detailing among primary care physicians practicing in urban underserved communities.

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