Abstract
ObjectiveTo assess whether the specialty of a patient’s primary care physician or being part of a gatekeeper plan influence breast and cervical cancer screening. Methods: Cross-sectional study of women in a national sample. For mammography, we studied women aged 40 and above, and for Papanicolaou (Pap) smear, women aged 18–65years. Screening mammography or Pap smear within the previous two years was measured by patient self-report. The key independent variables were primary care physician specialty and whether the patient had a gatekeeper. Results: Among women seen by a family practice physician, there was a higher probability of being screened if the patient was part of a gatekeeper plan than if the patient was not part of a gatekeeper plan: mammography (OR=1.35; 95 CI=1.20–1.52) and Pap smear (OR=1.60; 95 CI=1.34–1.91). Among women seen by an internal medicine physician, cancer screening did not vary significantly by gatekeeper status. Conclusions: The impact of gatekeeper plans upon cancer screening varies according to the primary care physician’s specialty. Policy interventions designed to increase cancer screening should take into account different responses to gatekeeper requirements among different types of providers.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Olsen O, Gotzsche PC (2001) Screening for breast cancer with mammography. Cochrane Database Syst Rev 4: CD001877.
InstitutionalAuthorNameU.S. Preventive Services Task Force (2002) ArticleTitleScreening for breast cancer: recommendations and Rationale Ann Intern Med 137 344–346
K Kerlikowske P Salzmann KA Phillips JA Cauley SR Cummings (1999) ArticleTitleContinuing screening mammography in women aged 70 to 79 years: impact on life expectancy and cost-effectiveness JAMA 282 2156–2163
JS Rich WC Black (2000) ArticleTitleWhen should we stop screening? Eff Clin Pract 3 78–84
SL Kulasingam JP Hughes NB Kiviat et al. (2002) ArticleTitleEvaluation of human papillomavirus testing in primary screening for cervical abnormalities: comparison of sensitivity, specificity, and frequency of referral JAMA 288 1749–1757
KE Hartman SA Hall K Nanda JF Boggess D Zolnoun (2002) Screening for Cervical Cancer: Systematic evidence review Agency for Healthcare Research and Quality Rockville, MD
SA Mayer-Oakes KA Atchison RE Matthias FJ Jong ParticleDe J Lubben SO Schweitzer (1996) ArticleTitleMammography use in older women with regular physicians: what are the predictors? Am J Prev Med 12 44–50
RB Burns EP McCarthy KM Freund et al. (1996) ArticleTitleVariability in mammography use among older women J Am Geriatr Soc 44 922–926
S Levy P Dowling L Boult A Monroe W McQuade (1992) ArticleTitleThe effect of physician and patient gender on preventive medicine practices in patients older than fifty Fam Med 24 58–61
N Lurie J Slater P McGovern et al. (1993) ArticleTitlePreventive care for women. Does the sex of the physician matter? N Engl J Med 329 478–482
MR Andersen N Urban (1997) ArticleTitlePhysician gender and screening: do patient differences account for differences in mammography use? Women Health 26 29–39
E Frank R Rothenberg C Lewis BF Belodoff (2000) ArticleTitleCorrelates of physicians’ prevention-related practices: findings from the women physicians’ health study Arch Fam Med 9 359–367
E Frank BK Rimer D Brogan L Elon (2000) ArticleTitleU.S. women physicians’ personal and clinical breast cancer screening practices J Womens Health Gend Based Med 9 791–801
KS Finison CA Wellins DE Wennberg FL Lucas (1999) ArticleTitleScreening mammography rates by specialty of the usual care physician Eff Clin Pract 2 120–125
RG Roetzheim SA Fox B Leake (1995) ArticleTitlePhysician-reported determinants of screening mammography in older women: the impact of physician and practice characteristics J Am Geriatr Soc 43 1398–1402
AG Pemberton KL Margolis PJ Mink PG McGovern N Lurie (1998) ArticleTitleWomen’s preferences for specialists who provide cancer screening and general medical care J Gen Intern Med 9 624–626
SH Taplin V Taylor D Montano R Chinn N Urban (1994) ArticleTitleSpecialty differences and the ordering of screening mammography by primary care physicians J Am Board Fam Pract 7 375–386
J Lomas (1991) ArticleTitleWords without action? The production, dissemination, and impact of consensus recommendations Annu Rev Public Health 12 41–65
AD Oxman MA Thomson DA Davis RB Haynes (1995) ArticleTitleNo magic bullets: a systematic review of 102 trials of interventions to improve professional practice Can Med Assoc J 153 1423–1431
M Wensing T Weijden Particlevan der R Grol (1998) ArticleTitleImplementing guidelines and innovations in general practice: which interventions are effective? Br J Gen Pract 48 991–997
JS Haas KA Phillips D Sonneborn et al. (2002) ArticleTitleEffect of managed care insurance on the use of preventive care for specific ethnic groups in the United States Med Care 40 743–751
DE DeLaet S Shea O Carrasquillo (2002) ArticleTitleReceipt of preventive services among privately insured minorities in managed care versus fee-for-service insurance plans J Gen Intern Med 17 451–457
EA Jacobs DS Lauderdale (2001) ArticleTitleReceipt of cancer screening procedures among Hispanic and non-Hispanic health maintenance organization members Cancer 91 257–261
LM Reisch MB Barton SW Fletcher W Kreuter JG Elmore (2000) ArticleTitleBreast cancer screening use by African Americans and Whites in an HMO J Gen Intern Med 15 229–234
KA Phillips JS Haas Liang et al. (2004) ArticleTitleAre gatekeeper requirements associated with cancer screening utilization? Health Serv Res 39 153–178
K Grumbach JV Selby C Damberg AB Bindman (1999) ArticleTitleResolving the gatekeeper conundrum: what patients value in primary care and referrals to specialists JAMA 282 261–266
InstitutionalAuthorNameResearch Agency for Healthcare Policy (1997) Methodology Report 2: Sample Design of the 1996 Medical Expenditure Panel Survey Household Component US Department of Health and Human Services Rockville, MD
U.S. Preventive Services Task Force (1996) Guide to Clinical Preventive Services. 2nd edn. Washington, DC: Office of Disease Prevention and Health Promotion. Accessed at http://www.ahrq.gov/clinic/cpsix.htm in March 2004.
DM Eddy (1989) ArticleTitleScreening for breast cancer Ann Intern Med 111 389–399
CT Lin G Albertson D Price R Swaney S Anderson RJ Anderson (2000) ArticleTitlePatient desire and reasons for specialist referral in a gatekeeper-model managed care plan Am J Manag Care 6 669–678
SR Tunis RS Hayward MC Wilson et al. (1994) ArticleTitleInternists’ attitudes about clinical practice guidelines Ann Intern Med 120 956–963
R Czaja SL McFall RB Warnecke L Ford AD Kaluzny (1994) ArticleTitlePreferences of community physicians for cancer screening guidelines Ann Intern Med 120 602–608
InstitutionalAuthorNameGynecologists American College of Obstetricians (1993) The Obstetrician–Gynecologist and Primary-Preventive Health Care American College of Obstetricians and Gynecologists Washington, DC
American Academy of Family Physicians (1994) Age charts for periodic health examination. Kansas City, MO: American Academy of Family Physicians. Accessed at http://www.aafp.org/exam in March 2003.
N Breen DK Wagener Ml Brown WW Davis R Ballard-Barbash (2001) ArticleTitleProgress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys J Natl Cancer Inst 93 1704–1713
J Parker T Gebretsadik F Sabogal J Newman HW Lawson (1998) ArticleTitleMammography screening among California Medicare beneficiaries: 1993–1994 Am J Prev Med 15 198–205
EK Adams CS Florence KE Thorpe ER Becker PJ Joski (2003) ArticleTitlePreventive care: female cancer screening, 1996–2000 Am J Prev Med 25 301–307
CS Lesser PB Ginsburg KJ Devers (2003) ArticleTitleThe end of an era: what became of the ‘managed care revolution’ in 2001? Health Serv Res 38 337–355
RH Brook JE Ware SuffixJr WH Rogers et al. (1983) ArticleTitleDoes free care improve adults’ health? Results from a randomized controlled trial N Engl J Med 309 1426–1434
E King B Rimer B Trock A Balshem P Engstrom (1990) ArticleTitleHow valid are mammography self-reports? Am J Public Health 80 1386–1388
NP Gordon RA Hiatt DL Lampert (1993) ArticleTitleConcordance of self-reported data and medical record audit for six cancer screening procedures J Natl Cancer Inst 85 566–570
J Zapka C Bigelow T Hurley et al. (1996) ArticleTitleMammography use among sociodemographically diverse women: the accuracy of self-report Am J Public Health 86 1016–1021
LS Caplan DV McQueen JR Qualters et al. (2003) ArticleTitleValidity of women’s self-reports of cancer screening test utilization in a managed care population Cancer Epidemiol Biomarkers Prev 12 1182–1187
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Haggstrom, D.A., Phillips, K.A., Liang, SY. et al. Variation in screening mammography and Papanicolaou smear by primary care physician specialty and gatekeeper plan (United States). Cancer Causes Control 15, 883–892 (2004). https://doi.org/10.1007/s10552-004-1138-5
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10552-004-1138-5