The quality of ambulatory care received by Medicare recipients who enrolled in health maintenance organizations (HMOs) was compared to the care received by fee-for-service (FFS) Medicare recipients, in a quasi-experimental, non-randomized design. Both samples were drawn from the four major geographic areas in the country, and included two types of HMO practices: staff/group models, and independent practice associations (IPAs). A panel of expert physicians developed criteria for evaluating ambulatory care, and medical record abstractions using these criteria were performed on 1,590 outpatient records: 777 FFS and 813 HMO (441 staff/group, 372 IPA). While individual items of medical histories and physical examinations were performed most often for staff/group HMO patients and least often in FFS patients, odds ratios (OR) for performance in staff/group HMO patients were particularly large for health maintenance items: tonometry (OR = 8.4), mammography (OR = 2.7), pelvic examination (OR = 5.3), rectal examina...

The quality of ambulatory care in Medicare health maintenance organizations.

A clinically effective breast cancer screening program can be cost-effective, too

A descriptive study was conducted to identify the relationship of knowledge, teaching methods, confidence and social influence to intent, frequency and proficiency of breast self-examination. A probability sample of 380 women aged 35 years and over served as subjects for in-home interviews conducted by trained graduate assistants. Knowledge correlated significantly with intent and proficiency of breast self-examination but not with frequency. Confidence correlated significantly with all three dependent variables, while social influence correlated only with intent. Being taught individually with a return demonstration increased proficiency and frequency. Implications for clinical application and future research are suggested.

Effect of knowledge, teaching method, confidence and social influence on breast self-examination behavior.

Two groups of residents in family practice were used to evaluate the effectiveness of a multifaceted educational program that was designed to increase resident compliance with screening for breast cancer. In the experimental group, residents were given a two-hour seminar that responded to the literature on the difficulties of implementing preventive care in clinical practice; group consensus was developed for a more regular (exact frequency left to each resident) screening for women aged over 35 years, and specific barriers to breast cancer screening were analyzed and solutions presented whenever possible. In addition, these residents received two behavioral cues after the intervention to stimulate and reinforce referrals for mammography screening. The study was conducted over a period of one year, including a five-month preintervention period, a three-month post-intervention period, and a three-month follow-up period. As predicted, the increase in mean referral rate for the experimental group was significantly greater than for the comparison group. This increased rate of referral for mammogram was maintained for six months after the intervention. This intervention is easily reproducible in many residency training programs, especially those in family medicine and other small primary care programs.

An intervention to increase mammography screening by residents in family practice.

From a review of the literature on studies on breast self examination (BSE), it is evident that BSE functions as an effective preventive health behavior. Only 19% to 40% of women practice BSE on a monthly basis, and there is no strong evidence that women who practice monthly BSE perform the procedure correctly. Confidence in BSE performance, prior BSE instruction, and finding some way to remember to do BSE were the factors most positively associated with frequent BSE practice. Women need to be given the facts about breast cancer and information about early detection methods and also need to be taught BSE in such a way that they feel confident in their BSE skills. The most effective way to teach BSE is to teach the woman on her own breasts. Since BSE is a skill, an accurate assessment of the learners' BSE techniques is necessary to adequately evaluate BSE teaching methods.

Practice and effectiveness of breast self examination: a selective review of the literature (1977-1989).

A patient questionnaire, chart audit, and resident questionnaire were used to assess clinical breast examination and breast self-examination experience in a family practice patient population. It was found that approximately 50 percent of the women studied reported annual routine breast examinations during a five-year study period. However, the residency program was responsible for providing or documenting annual clinical examinations in only ten percent of the population. Although 99 percent of the women knew about Breast Self-Examination (BSE), only 19 percent practiced monthly BSE. A positive association was found between the physician's active teaching of BSE and the patient's confidence in and regular practice of BSE. The low number of annual clinical examinations and low performance of BSE may be explained partially by the physician's setting too narrowly the parameters of when a clinical breast examination and BSE teaching could be done appropriately, ie, a pap smear/pelvic or general examination. A more aggressive approach by the physician may increase the number of women who get routine clinical breast examinations and who supplement them by monthly BSE.

Clinical breast examination and breast self-examination experience in a family practice population

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Clinical breast examination and breast self-examination experience in a family practice population