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Biomedical subjects

D S Lane

Publications and source records attributed to D S Lane.

At least 37 records · Page 2Linked to original sources
PubMed1992

Mammography referrals for elderly women: is Medicare reimbursement likely to make a difference?

Data from a survey of primary care physicians practicing in Long Island, New York in 1990 show that physicians report that they are less likely to refer all of their elderly female patients--those 75 years of age and older--for routine screening mammograms than their patients age 50 to 75. According to physicians' self-reports, out-of-pocket costs to the patient for screening mammography are not considered a major deterrent to referrals in this age group. Physicians' decisions to refer elderly patients are affected by the patients' state of health and are associated with the specialty of the physician: obstetrician/gynecologists (OBGYNs) are more likely to make routine referrals of elderly patients for screening mammography than are family practitioners and general internists. The results of this analysis suggest that the new Medicare reimbursement for biennial screening mammograms will not result in immediate increases in utilization by elderly women, unless their physicians become more convinced of the utility of widespread mammographic screening for the elderly patient.

Adult↗
PubMed1991

Mail versus telephone surveys on mammography utilization among women 50-75 years old.

Surveys are needed to monitor trends in mammography use and to evaluate intervention programs aimed at increasing breast cancer screening. In a community-based intervention project in Long Island (New York), estimated response rates were similar in separate random surveys of women 50-75 years old by mail and telephone. Respondents by mail (n = 2,368) and telephone (n = 1,011) were similar in distributions of age, marital status, and educational level, and mail respondents did not have higher income levels than telephone respondents. Reported utilization of breast cancer screening tests was similar by survey mode. A statistically significant positive association between mammography utilization and income level was evident in both mail and telephone surveys. These findings should promote the consideration of mail surveys in other studies of the utilization of breast cancer screening tests by various health care organizations.

Aged↗
PubMed1991

Risk perception, family history, and use of breast cancer screening tests.

A family history of breast cancer is an established risk factor for the disease, but there are few published studies on the use of breast cancer screening tests among family-history-positive women. Among 1015 respondents to telephone surveys of random samples of women 50 to 75 years old residing on Long Island (New York), the frequency of ever having had a mammogram or having a mammogram during the past year was significantly higher in respondents with a self-reported family history of breast cancer than in other women 50 to 64 (but not 65 to 75) years old. The association between family history and mammography during the past year held only among 50 to 64-year-old women with a lower perceived risk of breast cancer. Among women 50 to 64 years old, strong agreement with the ability of mammography to detect nonpalpable lumps was positively associated with mammography during the past year, especially among women with lower perceived risk of breast cancer. Implications are discussed with regard to breast cancer screening programs.

Adult↗
PubMed1991

Effect of continuing medical education and cost reduction on physician compliance with mammography screening guidelines.

BACKGROUND: Primary care physicians perform breast cancer screening in women aged 50 years and older less frequently than recommended by national guidelines. METHODS: A multimethod continuing medical education (CME) intervention was tested in an attempt to increase breast cancer screening practices in a predominantly fee-for-service practice community in New York State. Preintervention and postintervention surveys of primary care physicians were conducted in 1988 and 1990, respectively. Project-initiated, low-cost mammography in one town and the unanticipated provision of free mammography services in another town under nonproject auspices permitted a comparison to be made between these towns and towns where mammography screening was provided at the prevailing fees to determine the impact that cost has on physicians' referral of women patients for mammography. RESULTS: Physicians practicing in the towns in which the CME intervention was provided showed a significant increase, consistent across specialty groups and greatest among family physicians, in the number of reported mammography referrals of asymptomatic women aged 50 to 75 years. Changes in the CME control town were smaller and not statistically significant for the sample size available. The increase in compliance was as large in the CME-intervention towns, one without (19%) and one with low-cost mammography (20%), as the increase in the town with free mammography alone (18%). There were no significant increases in reported performance of breast examination. CONCLUSIONS: A multimethod program of CME is a feasible approach to increasing community physician compliance with mammography screening guidelines, particularly among family physicians, and can enhance the impact of reduced cost or have at least the equivalent effect of free mammography services.

Aged↗
PubMed1990

Age group differences in the use of breast cancer screening tests. The effects of health care utilization and socioeconomic variables.

The age-related decline in the use of breast cancer screening tests, specifically periodic mammography and physical breast examinations by a doctor, is especially problematic given that breast cancer risk increases with age. Survey data (N = 3,507) from the Awareness of Breast Cancer Project are used to compare the effects of socioeconomic variables and usual health care use variables on recent use of breast cancer screening tests in women 50 to 75 years of age on Long Island, New York. Having annual checkups and seeing an obstetrician/gynecologist for routine health care are the best predictors of recent mammography and breast physical exams for all women. Income level and education are not independent predictors of recent screening for women over 65. The implications of the effect of primary care practioners on periodic breast cancer screening in older women are discussed.

Age Factors↗
PubMed1990

Breast cancer screening. Changing physician practices and specialty variation.

Baseline surveys of primary care physicians and women on Long Island were conducted to determine breast cancer screening practices prior to introducing educational interventions to increase the use of mammography and breast examination in women aged 50 and older. Eighty-seven percent of the physicians (323) and 74% of the women (1,440) responded to postal surveys. Forty-eight percent of the physicians reported ordering regular screening mammograms on all asymptomatic female patients in this age group, with a significantly higher percentage reported by obstetrician/gynecologists than by family practitioners or internists. Only 24% of the women reported having had a mammogram within the past year. Lack of physician recommendation was the reason most frequently cited by women for not having had a mammogram. Findings point to the need for continuing medical education about consensus breast cancer screening guidelines, particularly the importance of combining both physical examination and mammography, and the need for patient education to minimize patient concerns.

Aged↗
PubMed1989

Promoting physician preventive practices: needs assessment for CME in breast cancer detection.

Needs assessment for a continuing medical education (CME) intervention directed at increasing breast cancer screening of women 50 years of age and older included a survey of target primary care physicians (n = 370) to explore areas of interest for CME in breast cancer detection and to establish baseline screening practices. The survey was completed at community hospital department meetings or by mail with a response rate of 87% (n = 323). Strategies for enhancing response rate and participation in planning included involvement of local physician organizations, use of a focus group of physicians, and attendance at community hospital department meetings. Survey results indicated that the topics of greatest interest for CME included improving patient compliance, risk factors, and patient education. A total of 48% of physician respondents reported referring all their asymptomatic female patients 50 years of age and older for regular screening mammograms; 63% indicated that they perform breast examinations on all such women regularly. Physician concerns that were reported to influence physical breast examination or referral for mammography are discussed, as well as current use of related office systems (e.g., for recall reminders and/or breast self-examination instruction). The results of a survey of women in the target age group residing in the same community are also reviewed in terms of mammography utilization (e.g., the proportion who had a screening mammogram within the last year was 19%) and specific concerns about mammography. The lack of a doctor's recommendation was the most common reason given (45%) for never having had a mammogram. The uses of the data from both surveys for CME program planning are discussed, including the content and design of the programs, along with organizational aspects and strategies for enhancing attendance.

Aged↗
PubMed1989

The impact of media coverage of Nancy Reagan's experience on breast cancer screening.

In surveys of random samples of women 50 years of age and older residing in two communities in Long Island, New York, both within-subject (cohort) and independent-sample comparisons were made before and after the media announcements of Nancy Reagan's breast cancer. Knowledge of lifetime risk of breast cancer increased significantly only in the cohort comparison, while self-perception of risk did not increase. Small proportions of women surveyed, however, reportedly were influenced to contact a health professional (6-8 percent) and to have their first mammogram (1.5-2 percent) which they attributed directly to Mrs. Reagan's experience with breast cancer.

Attitude to Health↗
PubMed1985

Reducing a resistant risk factor: analysis of an antismoking approach.

An 'I Quit Club' program was developed as a modification of the standard smoking withdrawal clinic format, to better meet the continuing need for assistance and to improve long term compliance by giving greater emphasis to the risk of relapse. Seventy-one percent of the 233 smokers who participated in the program during a 2-year period responded to a follow-up evaluation survey. At enrollment, data collected on a demographic characteristics, the length and level of the smoking habit, and motivation to quit. Registrants were surveyed subsequently to assess their current smoking status and the utility of the program components. At the time of follow-up 33% of all enrollees responding and 66% of those attending all six sessions were currently non-smokers. Those who completed the program had a significantly higher proportion of non-smokers than those who attended fewer than 6 sessions regardless of the length of time post-program. Success in quitting was also positively associated with non-smoking by family and friends. Seventy-four percent of respondents found the program to be helpful to very helpful. Their assessment of the value of each of the program components in decreasing order to utility was: the psychologist's lecture, group interactions, videotapes, and self-help manual, and relaxation exercises.

Behavior Therapy↗
PubMed1983

Compliance with referrals from a cancer-screening project.

Family practice residents participated in a federally funded breast and uterine cancer-screening project as a part of their training experience. During the 2.5-year grant period, more than 1,800 women were screened and 12 cancers detected. Patient compliance with referral for Pap smear findings was significantly greater when there were also positive pelvic findings or when the Pap smear indicated a malignant or premalignant condition. Compliance with referral for clinical follow-up of breast findings was comparable to that for diagnostic mammography, and both were significantly greater than compliance with referral for a screening mammogram. Significant relationships were found among compliance and the self-reporting of breast symptoms, the physical findings on physician examination, and the source of payment for mammography. The health belief model provides a conceptual framework for consideration of study findings relating to patient motivation for preventive and curative care.

Adult↗
PubMed1980

Long-term outcome of smoking cessation workshops.

Three hundred seventy-two (63%) of 590 enrollees in nine smoking cessation workshops held over a five-year period responded to a follow-up survey. Outcome data were collected retrospectively for six-month intervals from workshop to follow-up. Forty nine per cent of all enrollees graduated, and 56% of the respondents quit smoking during the program. Nonsmoking rates declined to an average of 25% by the first year post-workshop and remained relatively stable thereafter for periods up to five years.

Evaluation Studies as Topic↗
PubMed1979

Measures and methods in evaluating patient education programs for chronic illness.

Patient education provides a vehicle for increasing the self-management of chronic illness and promoting modifications of life styles, which are considered important strategies for prevention. Evaluating the impact of such programs is complex and poses a number of methodologic and technical problems. Outcome measures of patient education programs are defined and reviewed in terms of the existing evaluation literature and our own studies utilizing diabetes as a prototype condition. Important dimensions of adaptation are outlined and indices to measure it discussed in an effort to examine aspects of educational programs directed at facilitating coping and maintaining quality of life. Factors which influence outcome variables are identified and include: patient factors (e.g., age, ethnic, socioeconomic, cultural, personality, and emotional), disease factors (e.g., severity of illness, age of onset, length of illness, mode of therapy), system factors (e.g., patient's location in the health care system, relation of teaching program to other health care providers). The effects of these factors are described including their implications for research design.

Age Factors↗
PubMed1978

Patient education in the community hospital.

Recent events have led to a favorable climate for the development of hospital-based patient education. A pilot model program in a community hospital is utilized to illustrate the variety of settings in which patient education is conducted, and includes: group classes, patient clubs, volunteer visits, individual instruction, community outreach, screening and detection programs, and behavior modification workshops. The use of television for inpatient education is highlighted in a discussion of media approaches and needs.

Audiovisual Aids↗