Abstract
OBJECTIVE: To determine factors associated with having preventive screening tests in a population-based sample of Ontario women. DESIGN: Secondary analysis of data from Statistics Canada's National Population Health Survey linked to data from the Ontario Health Insurance Plan to ascertain whether women aged 20 or older had Pap smears, mammography, bone densitometry, or cholesterol testing. Factors associated with having testing were subjected to logistic regression analysis. SETTING: Ontario. PARTICIPANTS: Women aged 20 or older; from 19,600 Canadian households, 2232 Ontario women gave consent to linkage of administrative databases. MAIN OUTCOME MEASURES: Age-specific population screening rates. Odds ratios and probabilities of having screening in relation to socioeconomic, geographic, and physician-associated factors. RESULTS: Having screening was associated with age, income, education, and place of residence. Women with regular physicians were more likely to have Pap smears (odds ratio [OR] 4.4, range 1.7 to 12), densitometry (OR 22, range 3.6 to 140), and cholesterol testing (OR 8.0, range 2.3 to 29). Women who had periodic health examinations were more likely to have Pap smears (OR 6.7, range 4.6 to 9.8), mammograms (OR 3.7, range 2.3 to 5.9), densitometry (OR 3.7, range 1.3 to 10.5), and cholesterol testing (OR 3.0, range 2.0 to 4.5). The probability of having testing increased with number of visits a year to a doctor, but ceased to increase after three visits. CONCLUSION: Having screening tests was associated with socioeconomic factors including income, education, and place of residence. Patients who went to doctors for episodic care only were less likely to have preventive screening than patients who went for periodic health examinations.
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- Chaudhry R., Kottke T. E., Naessens J. M., Johnson T. J., Nyman M. A., Cornelius L. A., Petersen J. D. Busy physicians and preventive services for adults. Mayo Clin Proc. 2000 Feb;75(2):156–162. doi: 10.4065/75.2.156. [DOI] [PubMed] [Google Scholar]
- Choinière R., Lafontaine P., Edwards A. C. Distribution of cardiovascular disease risk factors by socioeconomic status among Canadian adults. CMAJ. 2000;162(9 Suppl):S13–S24. [PMC free article] [PubMed] [Google Scholar]
- Davies H. T., Crombie I. K., Tavakoli M. When can odds ratios mislead? BMJ. 1998 Mar 28;316(7136):989–991. doi: 10.1136/bmj.316.7136.989. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Flocke S. A., Stange K. C., Goodwin M. A. Patient and visit characteristics associated with opportunistic preventive services delivery. J Fam Pract. 1998 Sep;47(3):202–208. [PubMed] [Google Scholar]
- Frame P. S. Health maintenance in clinical practice: strategies and barriers. Am Fam Physician. 1992 Mar;45(3):1192–1200. [PubMed] [Google Scholar]
- Hutchison B. G., Abelson J., Woodward C. A., Norman G. Preventive care and barriers to effective prevention. How do family physicians see it? Can Fam Physician. 1996 Sep;42:1693–1700. [PMC free article] [PubMed] [Google Scholar]
- Hutchison B., Woodward C. A., Norman G. R., Abelson J., Brown J. A. Provision of preventive care to unannounced standardized patients. CMAJ. 1998 Jan 27;158(2):185–193. [PMC free article] [PubMed] [Google Scholar]
- Jaén C. R., Stange K. C., Nutting P. A. Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract. 1994 Feb;38(2):166–171. [PubMed] [Google Scholar]
- Luckmann R., Melville S. K. Periodic health evaluation of adults: a survey of family physicians. J Fam Pract. 1995 Jun;40(6):547–554. [PubMed] [Google Scholar]
- McIsaac W. J., Fuller-Thomson E., Talbot Y. Does having regular care by a family physician improve preventive care? Can Fam Physician. 2001 Jan;47:70–76. [PMC free article] [PubMed] [Google Scholar]
- Montaño D. E., Phillips W. R. Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit. Am J Public Health. 1995 Jun;85(6):795–800. doi: 10.2105/ajph.85.6.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Redelmeier D. A., Tu J. V., Schull M. J., Ferris L. E., Hux J. E. Problems for clinical judgement: 2. Obtaining a reliable past medical history. CMAJ. 2001 Mar 20;164(6):809–813. [PMC free article] [PubMed] [Google Scholar]
- Ridout R., Hawker G. A. Use of bone densitometry by Ontario family physicians. Osteoporos Int. 2000;11(5):393–399. doi: 10.1007/s001980070105. [DOI] [PubMed] [Google Scholar]
- Ruffin M. T., 4th Can we change physicians' practices in the delivery of cancer-preventive services? Arch Fam Med. 1998 Jul-Aug;7(4):317–319. doi: 10.1001/archfami.7.4.317. [DOI] [PubMed] [Google Scholar]
- Smith H. E., Herbert C. P. Preventive practice among primary care physicians in British Columbia: relation to recommendations of the Canadian Task Force on the Periodic Health Examination. CMAJ. 1993 Dec 15;149(12):1795–1800. [PMC free article] [PubMed] [Google Scholar]
- Stange K. C., Flocke S. A., Goodwin M. A., Kelly R. B., Zyzanski S. J. Direct observation of rates of preventive service delivery in community family practice. Prev Med. 2000 Aug;31(2 Pt 1):167–176. doi: 10.1006/pmed.2000.0700. [DOI] [PubMed] [Google Scholar]
- Stange K. C., Kelly R., Chao J., Zyzanski S. J., Shank J. C., Jaén C. R., Melnikow J., Flocke S. Physician agreement with US Preventive Services Task Force recommendations. J Fam Pract. 1992 Apr;34(4):409–416. [PubMed] [Google Scholar]
- Tambay J. L., Catlin G. Sample design of the national population health survey. Health Rep. 1995;7(1):29-38, 31-42. [PubMed] [Google Scholar]
- Zyzanski S. J., Stange K. C., Langa D., Flocke S. A. Trade-offs in high-volume primary care practice. J Fam Pract. 1998 May;46(5):397–402. [PubMed] [Google Scholar]