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Communication factors in the follow-up of abnormal mammograms

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Abstract

OBJECTIVE: To identify the communication factors that are significantly associated with appropriate short-term follow-up of abnormal mammograms.

DESIGN: Prospective longitudinal study involving medical record review and patient survey.

SETTING: Ten academically affiliated ambulatory medical practices in the Boston metropolitan area.

PARTICIPANTS: One hundred twenty-six women with abnormal mammograms requiring short-term (6 months) follow-up imaging.

MEASUREMENTS: Proportion of women in the study who received appropriate follow-up care.

RESULTS: Eighty-one (64%) of the women with abnormal mammograms requiring short-term follow-up imaging received the appropriate follow-up care. After adjusting for patients’ age and insurance status, 2 communication factors were found to be independently associated with the delivery of appropriate follow-up care: 1) physicians’ documentation of a follow-up plan in the medical record (adjusted odds ratio, 2.79; 95% confidence interval, 1.11 to 6.98; P=.029); and 2) patients’ understanding of the need for follow-up (adjusted odds ratio, 3.86; 95% confidence interval, 1.50 to 9.96; P=.006). None of the patients’ clinical or psychological characteristics were associated with the delivery of appropriate follow-up care.

CONCLUSIONS: Follow-up care for women with abnormal mammograms requiring short-term follow-up imaging is suboptimal. Documentation of the follow-up plan by the physician and understanding of the follow-up plan by the patient are important factors that are correlated with the receipt of appropriate follow-up care for these women. Interventions designed to improve the quality of result follow-up in the outpatient setting should address these issues in patient-doctor communication.

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Authors and Affiliations

  1. the Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Mass

    Eric G. Poon MD, MPH, Jennifer S. Haas MD, MPSH, Ann Louise Puopolo RN, BSN, Tejal K. Gandhi MD, MPH, Elisabeth Burdick MA, David W. Bates MD, MSc & Troyen A. Brennan MD, JD, MPH

  2. Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass

    David W. Bates MD, MSc & Troyen A. Brennan MD, JD, MPH

Authors
  1. Eric G. Poon MD, MPH
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  2. Jennifer S. Haas MD, MPSH
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  3. Ann Louise Puopolo RN, BSN
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  4. Tejal K. Gandhi MD, MPH
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  5. Elisabeth Burdick MA
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  6. David W. Bates MD, MSc
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  7. Troyen A. Brennan MD, JD, MPH
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Corresponding author

Correspondence to Eric G. Poon MD, MPH.

Additional information

This power calculation assumes 1) a 34 to 66 distribution in the risk factor of interest, and 2) the group without the risk factor had a 0.4 probability for receiving adequate follow-up and the group with the risk factor had a 0.6 probability of receiving adequate follow-up.

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Poon, E.G., Haas, J.S., Puopolo, A.L. et al. Communication factors in the follow-up of abnormal mammograms. J GEN INTERN MED 19, 316–323 (2004). https://doi.org/10.1111/j.1525-1497.2004.30357.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30357.x

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