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Department of Medicine, Lombardi Cancer Center, Georgetown University Medical Center, Washington, D.C. 20007 [J. S. M.]; MEDTAP International, Bethesda, Maryland 20007 [K. R. Y.]; and Johns Hopkins School of Hygiene and Public Health, Department of Epidemiology, Baltimore, Maryland 21205-2179 [K. R. Y.]
The objective of this study was to determine the effectiveness of interventions targeted at providers to enhance the use of mammography. We performed a meta-analysis and included United States studies that used a randomized or nonrandomized concurrent control design, had defined outcomes, and presented data that could be abstracted for reanalysis. Interventions were classified as behavioral, cognitive, or sociological and further categorized by the type of control group (active versus usual care). Data were combined using DerSimonian and Laird random effects models to yield summary effect sizes. Thirty-five studies met the inclusion criteria. All types of interventions targeted at providers were effective in increasing mammography rates. Behavioral interventions increased screening by 13.2% [95% confidence interval (CI), 7.8–18.4] as compared with usual care and by 6.8% (95% CI, 4.8–8.7) as compared with active controls. Cognitive intervention strategies improved mammography rates by 18.6% (95% CI, 12.8–24.4). Sociological interventions also had a similar magnitude of effect on screening rates (13.1% increase; 95% CI, 6.8–19.3). Interventions targeting both patients and providers were not significantly better at increasing screening than those targeting providers alone, and multiple approaches (e.g., behavioral and cognitive) were generally not more effective than a single approach. All interventions targeted at physicians were effective in increasing screening rates. Decisions to use a particular approach will depend on resources, expertise, feasibility, and cost effectiveness.
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