Table 3.
Bivariate Associations of Predisposing, Enabling, and Reinforcing Factors with Mammography Referrals According to Setting, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2001–2003
| Visits to Office–Based Primary Care Physicians | Visits to Hospital Outpatient Clinics | |||||
|---|---|---|---|---|---|---|
| na | %a of Visits with Mammography Referrals | CI | na | %a of Visits with Mammography Referrals | CI | |
| Predisposing Factors | ||||||
| Patient Age (yrs) | p<.001 | p=.009 | ||||
| 40–49 | 2,464 | 9.4 | 7.9–11.2 | 5,456 | 5.8 | 4.7–7.1 |
| 50–59 | 2,136 | 11.2 | 9.5–13.2 | 4,504 | 5.6 | 4.5–6.9 |
| 60–69 | 1,544 | 7.5 | 6.0–9.4 | 3,389 | 5.4 | 4.0–7.3 |
| ≥ 70 | 2,612 | 3.7 | 2.9–4.7 | 3,718 | 3.4 | 2.5–4.7 |
| Patient Race | p=.686 | p=.053 | ||||
| White only | 7,694 | 7.9 | 6.9–8.9 | 12,529 | 4.7 | 3.8–5.7 |
| Black only | 802 | 6.6 | 4.3–9.9 | 3,912 | 6.8 | 5.3–8.8 |
| Asian/Pacific Islander only | 260 | 7.3 | 4.4–12.0 | 626 | 5.5 | 3.7–8.2 |
| Patient Ethnicity | p=.040 | p=.022 | ||||
| Hispanic | 537 | 5.1 | 3.4–7.6 | 2,154 | 7.2 | 5.4–9.6 |
| Not Hispanic | 6,879 | 8.2 | 7.2–9.3 | 13,182 | 4.9 | 4.1–6.0 |
| Reason for visit | p<.001 | p<.001 | ||||
| Chronic problem | 3,533 | 3.6 | 2.8–4.5 | 7,829 | 3.5 | 2.7–4.6 |
| Acute problem | 3,378 | 2.1 | 1.6–2.7 | 6,043 | 1.9 | 1.4–2.5 |
| Preventive care | 1,510 | 31.9 | 28.1–35.9 | 2,265 | 22.9 | 18.6–27.8 |
| Enabling Factors | ||||||
| Expected source of payment | p<.001 | p=.182 | ||||
| Medicare | 2,846 | 4.4 | 3.6–5.3 | 4,735 | 4.2 | 3.2–5.6 |
| Medicaid | 466 | 3.1b | 1.6–6.0 | 3,357 | 5.5 | 4.3–7.0 |
| Private | 4,585 | 10.8 | 9.4–12.4 | 5,255 | 4.7 | 3.5–6.3 |
| Other | 217 | 7.0b | 3.3–14.3 | 825 | 5.0 | 3.0–8.1 |
| Self/uninsured | 395 | 3.6 | 2.0–6.4 | 1,999 | 7.3 | 5.4–9.8 |
| # of visits to practicec | p<.001 | p<.001 | ||||
| New patient | 484 | 12.5 | 9.0–17.1 | 2,119 | 4.1 | 2.8–5.9 |
| 0 | 573 | 28.4 | 23.7–33.6 | 852 | 15.3 | 9.4–23.9 |
| 1–2 | 2,235 | 10.6 | 8.8–12.7 | 3,943 | 6.8 | 5.6–8.3 |
| 3–5 | 2,674 | 4.5 | 3.6–5.6 | 3,988 | 4.5 | 3.5–5.8 |
| ≥ 6 | 2,360 | 3.0 | 2.1–4.2 | 4,651 | 3.1 | 2.3–4.2 |
| Time spent with physician | p<.001 | NA | ||||
| < 15 minutes | 2,030 | 4.4 | 3.2–6.1 | |||
| 15–<30 minutes | 5,213 | 7.5 | 6.4–8.9 | |||
| ≥ 30 minutes | 1,513 | 13.1 | 10.3–16.6 | |||
| Reinforcing Factors | ||||||
| Physician gender | p<.001 | NA | ||||
| Male | 6,604 | 6.4 | 5.4–7.5 | |||
| Female | 2,152 | 11.8 | 9.5–14.6 | |||
| Physician age (yrs) | p=.194 | NA | ||||
| < 45 | 3,146 | 6.6 | 5.4–8.0 | |||
| 45–54 | 3,393 | 8.0 | 6.5–9.8 | |||
| ≥ 55 | 2,217 | 9.0 | 6.6–12.0 | |||
| PCP status | p<.001 | p=.201 | ||||
| PCP for that patient | 6,508 | 4.8 | 4.1–5.7 | 6,962 | 5.6 | 4.4–7.1 |
| Not PCP for that patient | 1,777 | 18.5 | 15.6–21.8 | 8,319 | 4.4 | 3.3–5.9 |
| Physician specialty | p<.001 | NA | ||||
| Internal Medicine | 2,534 | 3.7 | 2.7–5.1 | |||
| General/family practice | 4,734 | 4.4 | 3.6–5.4 | |||
| Obstetrics and gynecology | 1,488 | 28.1 | 24.3–32.2 | |||
| Clinic type | NA | p<.001 | ||||
| General Medicine | 14,492 | 4.2 | 3.4–5.2 | |||
| Obstetrics and gynecology | 2,575 | 17.0 | 14.1–20.4 | |||
| Solo vs group practice | p=.122 | NA | ||||
| Solo | 3,313 | 6.7 | 5.2–8.4 | |||
| Group | 5,443 | 8.4 | 7.2–9.8 | |||
| MSAd | p<.001 | p=.037 | ||||
| MSA | 6,914 | 8.6 | 7.6–9.7 | 14,733 | 5.7 | 4.7–6.8 |
| Non-MSA | 1,842 | 3.8 | 2.7–5.4 | 2,334 | 3.3 | 1.8–5.8 |
| Geographic region | p=.931 | p=.019 | ||||
| Northeast | 1,760 | 8.1 | 6.2–10.7 | 4,930 | 6.9 | 5.5–8.7 |
| Midwest | 2,185 | 7.5 | 6.0–9.2 | 5,205 | 5.8 | 4.3–7.6 |
| South | 2,873 | 7.4 | 6.0–9.0 | 4,461 | 3.9 | 2.6–5.8 |
| West | 1,938 | 8.0 | 6.1–10.4 | 2,471 | 3.7 | 2.5–5.5 |
Percentages were calculated using weighted national survey estimates. Ns are unweighted. Unweighted data from the NAMCS and NHAMCS are not nationally representative and are included merely as indicators of sample size.
Estimates should be interpreted with caution due to relative standard error ≥ 30%.
Does not include index visit.
MSA = metropolitan statistical area.
NA = not available.
Note: Statistical testing for differences in mammography referral across levels of predisposing, enabling, and reinforcing factors performed using the Pearson chi-square test.