The simultaneous analysis of patient, physician and group practice influences on annual mammography performance.

The current study examined the relationship of several variables at the patient (n = 2780), physician (n = 166), and group practice (n = 45) levels for predicting receipt of annual mammography screening. Patient-level variables included constructs from the Triandis Model of Choice; physician-level variables included measures of barriers and receptivity to prevention, as well as demographic information. Hierarchical modeling demonstrated that variables at the patient and physician level reliably predict annual mammography screening, while frequency of screening did not vary across group practices after accounting for patient and physician variables. Patient-level predictors included social norms, perceived consequences and perceived barriers. The only physician-level predictor identified was annual mammography recommendation. These findings add to data which emphasize the importance of public education and social support in health maintenance activities.

Are clinicians intervening with their patients who smoke? A "real-world" assessment of 45 clinics in the upper Midwest.

OBJECTIVE: To determine the level of intervention provided by primary care physicians to individuals who smoke. SETTING: 45 primary care clinics throughout the upper Midwest. PATIENTS: 6,086 men and women (M:F = 1:2), ages 50 to 68, who sought medical care at any one of the 45 primary care clinics and completed two questionnaires regarding preventive medical services received during the previous 3 years (1990-1993). RESULTS: Of patients who smoke, 92% reported that their clinician had asked about their smoking status. Additionally, 86% reported being informed at their clinic of the dangers of tobacco use. A smaller percentage of individuals (60.1%) reported being explicitly advised on how to quit, and fewer still (27.2%) reported being referred to a stop smoking program. CONCLUSIONS: While most clinicians inquire about their patients' smoking status and recommend they quit, there currently exists a deficiency in the translation of these recommendations into concise, explicit instructions on how to quit. By increasing the frequency of clinicians giving specific advice about how to quit, the overall success rate of the public health campaign against tobacco use will be greatly enhanced.