Specialty differences and the ordering of screening mammography by primary care physicians.

BACKGROUND: Careful attention to factors that affect women and their physicians is necessary to achieve the national goal that, by the year 2000, 60 percent of women should have had a screening mammogram in the previous 2 years. This report evaluates factors that differentiate primary care physicians who regularly order mammograms from those who do not. The study was conducted as part of a large demonstration project in Washington State and includes a survey of women served by the physicians.

METHODS: We conducted a survey of primary care physicians and women in four counties to assess factors that influenced self-reported ordering of screening mammography.

RESULTS: Among the 73 percent of family physicians, general practitioners, internists, and obstetrician-gynecologists who returned the questionnaire, there were more obstetrician-gynecologists (76 percent) who reported ordering screening mammograms in 90 percent or more of women aged 50 to 75 years, but they cared for only 15 percent of women in the sample. Women's survey results confirmed the physicians' reported differences and also revealed demographic characteristics that distinguished populations associated with particular primary care specialists. These specialists differed in their perceptions of their colleague's mammography practices, the adequacy of insurance coverage, and how often they had spent an unreasonable time explaining mammography results. In a multivariate model of factors expected to influence behavior, performance of clinical breast examination rather than specialty was the salient factor associated with ordering screening mammography.

CONCLUSIONS: These results suggest that the context of practice, rather than specialty type or beliefs about mammography, has the major influence upon behavior. To achieve national screening mammography goals in the Northwest, we must influence the context of family physicians' preventive care practices because they care for 47 percent of women aged 50 years or older.