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Primary care physician specialty influences use of screening mammography and Pap smears in gatekeeper plans

Patients in gatekeeper health plans must have a referral from their primary care provider in order to see specialists or obtain special procedures such as mammograms. The impact of gatekeeper plans on cancer screening varies according to the specialty of a woman's primary care physician, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10771 and HS10856). For instance, the use of mammography to screen for breast cancer and Pap smears to screen for cervical cancer among patients of internal medicine physicians appeared to be unaffected by enrollment in a gatekeeper plan. In contrast, screening rates increased if family practice physicians were in gatekeeper plans.

Researchers from the University of California, San Francisco, and Brigham and Women's Hospital in Boston linked 1996 data on women who responded to the 1996 Medical Expenditure Panel Survey Household Component (MEPS-HC) with data from the MEPS Health Insurance Plan Abstraction (MEPS-HIPA) data file. They examined use of screening mammography (women aged 40 and over) and Pap smears (women aged 18 to 65) in the preceding 2 years in gatekeeper plans by physician specialty. Women in gatekeeper plans (about half of those surveyed) were more likely than women not in gatekeeper plants to receive screening mammography (77 vs. 71 percent) and screening Pap smears (84 vs. 74 percent).

However, women whose primary care physician was a family practice physician were 30 percent more likely to have a mammogram and 60 percent more likely to have a Pap smear if they were part of a gatekeeper plan rather than a non-gatekeeper plan.

Among women seen by an internal medicine physician, screening did not vary significantly by gatekeeper status. Different cultures of practice may exist in the specialties of family practice and internal medicine, conclude the researchers.

See "Variation in screening mammography and Papanicolaou smear by primary care physician specialty and gatekeeper plan (United States), by David A. Haggstrom, M.D., Kathryn A. Phillips, Ph.D., Su-Ying Liang, Ph.D., and others, in Cancer Causes and Control 15, pp. 883-892, 2004.

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