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OtherFamily Medicine And The Health Care System

Improving Mammography Screening Using Best Practices and Practice Enhancement Assistants: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

Cheryl B. Aspy, Margaret Enright, LaWanna Halstead and James W. Mold
The Journal of the American Board of Family Medicine July 2008, 21 (4) 326-333; DOI: https://doi.org/10.3122/jabfm.2008.04.070060
Cheryl B. Aspy
PhD
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Margaret Enright
MPH
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LaWanna Halstead
RN, MPH
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James W. Mold
MD, MPH
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Article Figures & Data

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    Table 1.

    Methods Used By Primary Care Clinician Exemplars to Achieve High Rates of Mammography Screening in Their Patients

    1. Make a commitment to provide prevention services, both personally and as a practice, focusing on the most important preventive services and making sure that all eligible patients are offered those services. Think about preventive services at every visit with every patient. Suggestions for critical adult preventive services include:
    1. Colorectal cancer screening for all ages 50 and older;

    2. Mammography for women beginning at age 40;

    3. Cervical cancer screening for women ages 18 to 65;

    4. Influenza vaccination for all ages 50 and older and anyone else who wants it;

    5. One-time pneumococcal vaccination for all ages 50 and older.

    2. Use a clinician/nurse reminder system of some type such as:
    1. Preventive services flow sheet;

    2. Special mammography stickers for women older than 40;

    3. Preventive services reminder card that nurses complete.

    3. Make the mammography appointment for the patient. (Don't ask the patient to do it.) Caveats include:
    1. Ask the patient what day and time would be best (before they leave the office) so that the appointment made by your office will be convenient for them;

    2. Discuss potential barriers with patients who have missed or delayed their mammograms and ask them what it would take to get them in for their mammography.

    4. Use only 1 mammography center for almost all of your patients. Select the referral center based on the following:
    1. Appointments should generally be available within 2 weeks;

    2. Mammography center should always send a report to the patient and to you;

    3. Mammography center should let you know when patients miss their scheduled appointment;

    4. Mammography center should send a reminder to the patient every year (or as indicated);

    5. Mammography center should do further testing without bothering you for additional orders.

    5. Schedule well adult examinations on a regular basis to catch up on any preventive services that have been missed.
    • View popup
    Table 2.

    Methods Used by Intervention Practices to Improve Mammography Screening

    ClinicianRate Before/After Intervention (%)Method 1Method 2Method 3Method 4Method 5
    A28/71Very committed to preventionNurses check chart at each visit for all prevention services neededAppointment was made at check-outAppointments were tracked and followed up if not kept
    B48/75Very committed to preventionNurses checked mammogram eligibility at each visitReferral was made at check-outAppointments were tracked and followed up if not kept
    C35/56Very committed to preventionNurses checked mammogram eligibility at each visitAppointment was made at check-outUsed one referral center
    D35/52Very committed to preventionNurses checked mammogram eligibility at each visitReferral was made at check-outWomen eligible for a mammogram were contacted for an appointment
    E62/70Very committed to preventionNurses asked eligible women about mammographyReferral was made at check-out
    F25/28Prevention was not a priorityNurses asked eligible women about mammographyReferral was made at check-out
    G56/56Committed to preventionNurses checked mammogram eligibility at each visitReferral was made at check-out
    H21/21Prevention was not a priorityUsed one center but expected patients to self-refer
    • View popup
    Table 3.

    Comparison of Usual Care and Intervention Practices' Demographic Characteristics and Outcomes Before and After Intervention

    Usual Care Practices (n = 8)*Intervention Practices (n = 8)†P
    BeforeAfterBeforeAfter
    Patient age‡x̄ = 66.3; s = 3.8x̄ = 67.2; s = 3.1x̄ = 66.9; s = 3.26x̄ = 65.6; s = 2.5>.05
    Insurance status (%)
        Private36343739>.05
        All other64666361
    Current mammogram (%)‡40354052.015
    • * Total patients of usual care group before interevention, 688; after intervention, 576.

    • † Total patients of intervention group, before intervention, 678; after intervention, 639.

    • ‡ t test of change scores.

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The Journal of the American Board of Family Medicine: 21 (4)
The Journal of the American Board of Family Medicine
Vol. 21, Issue 4
July-August 2008
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Improving Mammography Screening Using Best Practices and Practice Enhancement Assistants: An Oklahoma Physicians Resource/Research Network (OKPRN) Study
Cheryl B. Aspy, Margaret Enright, LaWanna Halstead, James W. Mold
The Journal of the American Board of Family Medicine Jul 2008, 21 (4) 326-333; DOI: 10.3122/jabfm.2008.04.070060

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Improving Mammography Screening Using Best Practices and Practice Enhancement Assistants: An Oklahoma Physicians Resource/Research Network (OKPRN) Study
Cheryl B. Aspy, Margaret Enright, LaWanna Halstead, James W. Mold
The Journal of the American Board of Family Medicine Jul 2008, 21 (4) 326-333; DOI: 10.3122/jabfm.2008.04.070060
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