BMJ  1992;304:687-691 (14 March), doi:10.1136/bmj.304.6828.687

Cancer: improving early detection and prevention. A community practice randomised trial.

Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Hanover, NH 03756.

OBJECTIVE--To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN--A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS--Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS--The education intervention consisted of a day long physician meeting directed at improving knowledge, attitudes, and skills relevant to cancer prevention and early detection. The office system intervention consisted of assistance from a project facilitator in establishing routines for providing needed services. These routines included division of responsibilities for providing services among physicians and their staff and the use of medical record flow sheets. MAIN OUTCOME MEASURES--The proportions of patients provided the cancer prevention and early detection services indicated annually according to the US National Cancer Institute. RESULTS--Based on cross sectional patient surveys, the office system intervention was associated with an increase in mammography, the recommendation to do breast self examination, clinical breast examination, faecal occult blood testing, advice to quit smoking, and the recommendation to decrease dietary fat. Education was associated only with an increase in mammography. Record review for a patient cohort confirmed cross sectional survey findings regarding the office system for mammography and faecal occult blood testing. CONCLUSION--Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Facilitating prevention in primary care.

G. Fowler, E. Fullard, and M. Gray
BMJ 1992 304: 1177. [PDF]

Facilitating prevention in primary care.

D. Mant
BMJ 1992 304: 652-653. [PDF]

This article has been cited by other articles:

• Petrova, M., Dale, J., Munday, D., Koistinen, J., Agarwal, S., Lall, R. (2009). The role and impact of facilitators in primary care: findings from the implementation of the Gold Standards Framework for palliative care. Fam Pract 0: cmp066v1-cmp066 [Abstract] [Full text]  
• Hudson, S. V., Ohman-Strickland, P., Ferrante, J. M., Lu-Yao, G., Orzano, A. J., Crabtree, B. F. (2009). Prostate-Specific Antigen Testing among the Elderly in Community-Based Family Medicine Practices. J Am Board Fam Med 22: 257-265 [Abstract] [Full text]  
• Newton, W. P. (2008). Improving Performance in Prevention. J Am Board Fam Med 21: 258-260 [Full text]  
• Aspy, C. B., Enright, M., Halstead, L., Mold, J. W. (2008). Improving Mammography Screening Using Best Practices and Practice Enhancement Assistants: An Oklahoma Physicians Resource/Research Network (OKPRN) Study. J Am Board Fam Med 21: 326-333 [Abstract] [Full text]  
• Mold, J. W., Aspy, C. A., Nagykaldi, Z. (2008). Implementation of Evidence-Based Preventive Services Delivery Processes in Primary Care: An Oklahoma Physicians Resource/Research Network (OKPRN) Study. J Am Board Fam Med 21: 334-344 [Abstract] [Full text]  
• Hogg, W, Lemelin, J, Graham, I., Grimshaw, J, Martin, C, Moore, L, Soto, E, O'Rourke, K (2008). Improving prevention in primary care: evaluating the effectiveness of outreach facilitation. Fam Pract 25: 40-48 [Abstract] [Full text]  
• Boom, J. A., Nelson, C. S., Laufman, L. E., Kohrt, A. E., Kozinetz, C. A. (2007). Improvement in Provider Immunization Knowledge and Behaviors Following a Peer Education Intervention. CLIN PEDIATR 46: 706-717 [Abstract]  
• Ahles, T. A., Wasson, J. H., Seville, J. L., Johnson, D. J., Cole, B. F., Hanscom, B., Stukel, T. A., McKinstry, E. (2006). A Controlled Trial of Methods for Managing Pain in Primary Care Patients With or Without Co-Occurring Psychosocial Problems. Ann Fam Med 4: 341-350 [Abstract] [Full text]  
• Dietrich, A. J., Tobin, J. N., Cassells, A., Robinson, C. M., Greene, M. A., Sox, C. H., Beach, M. L., DuHamel, K. N., Younge, R. G. (2006). Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial.. ANN INTERN MED 144: 563-571 [Abstract] [Full text]  
• Lindbloom, E. J. (2005). DIETRICH RECEIVES CURTIS G. HAMES RESEARCH AWARD, CALL FOR NEW MODEL PAPERS. Ann Fam Med 3: 373-375 [Full text]  
• Roetzheim, R. G., Christman, L. K., Jacobsen, P. B., Schroeder, J., Abdulla, R., Hunter, S. (2005). Long-term Results From a Randomized Controlled Trial to Increase Cancer Screening Among Attendees of Community Health Centers. Ann Fam Med 3: 109-114 [Abstract] [Full text]  
• Roetzheim, R. G., Christman, L. K., Jacobsen, P. B., Cantor, A. B., Schroeder, J., Abdulla, R., Hunter, S., Chirikos, T. N., Krischer, J. P. (2004). A Randomized Controlled Trial to Increase Cancer Screening Among Attendees of Community Health Centers. Ann Fam Med 2: 294-300 [Abstract] [Full text]  
• Dietrich, A. J., Oxman, T. E., Williams, J. W. Jr, Kroenke, K., Schulberg, H. C., Bruce, M., Barry, S. L. (2004). Going to Scale: Re-Engineering Systems for Primary Care Treatment of Depression. Ann Fam Med 2: 301-304 [Abstract] [Full text]  
• Weller, D, May, F, Rowett, D, Esterman, A, Pinnock, C, Nicholson, S, Doust, J, Silagy, C (2003). Promoting better use of the PSA test in general practice: randomized controlled trial of educational strategies based on outreach visits and mailout. Fam Pract 20: 655-661 [Abstract] [Full text]  
• Piper, M. E., Fiore, M. C., Smith, S. S., Jorenby, D. E., Wilson, J. R., Zehner, M. E., Baker, T. B. (2003). Use of the Vital Sign Stamp as a Systematic Screening Tool to Promote Smoking Cessation. Mayo Clin Proc. 78: 716-722 [Abstract]  
• (2002). References. Circulation 106: 3373-3421 [Full text]  
• Davis, D., O'Brien, M. A. T., Freemantle, N., Wolf, F. M., Mazmanian, P., Taylor-Vaisey, A. (1999). Impact of Formal Continuing Medical Education: Do Conferences, Workshops, Rounds, and Other Traditional Continuing Education Activities Change Physician Behavior or Health Care Outcomes?. JAMA 282: 867-874 [Abstract] [Full text]  
• Nutting, P. A., Beasley, J. W., Werner, J. J. (1999). Practice-Based Research Networks Answer Primary Care Questions. JAMA 281: 686-688 [Full text]  
• Sox, C. H., Dietrich, A. J., Tosteson, T. D., Winchell, C. W., Labaree, C. E. (1997). Periodic Health Examinations and the Provision of Cancer Prevention Services. Arch Fam Med 6: 223-230 [Abstract]  
• LeBaron, C. W., Chaney, M., Baughman, A. L., Dini, E. F., Maes, E., Dietz, V., Bernier, R. (1997). Impact of Measurement and Feedback on Vaccination Coverage in Public Clinics, 1988-1994. JAMA 277: 631-635 [Abstract]  
• Woodruff, C. B., Dietrich, A. J., Carney, P. A., Frechette, J. I., Camp, M. A., Fitzgerald, B. S. (1996). Volunteer Facilitators Assist Community Practices With Enhancing Cancer Control. Arch Fam Med 5: 560-565 [Abstract]  
• Leininger, L. S., Finn, L., Dickey, L., Dietrich, A. J., Foxhall, L., Garr, D., Stewart, B., Wender, R. (1996). An Office System for Organizing Preventive Services: A Report by the American Cancer Society Advisory Group on Preventive Health Care Reminder Systems. Arch Fam Med 5: 108-115 [Abstract]  
• Davis, D. A., Thomson, M. A., Oxman, A. D., Haynes, R. B. (1995). Changing Physician Performance: A Systematic Review of the Effect of Continuing Medical Education Strategies. JAMA 274: 700-705 [Abstract]  
• Thompson, R. S., Taplin, S. H., McAfee, T. A., Mandelson, M. T., Smith, A. E. (1995). Primary and Secondary Prevention Services in Clinical Practice: Twenty Years' Experience in Development, Implementation, and Evaluation. JAMA 273: 1130-1135 [Abstract]  
• McPhee, S. J. (1994). Computer-Assisted Preventive Care: Time to 'Byte' the Bullet?. Arch Fam Med 3: 576-578 [Abstract]  
• Dietrich, A. J., Woodruff, C. B., Carney, P. A. (1994). Changing Office Routines to Enhance Preventive Care: The Preventive GAPS Approach. Arch Fam Med 3: 176-183 [Abstract]  

Online poll

Find out more on doc2doc >>