title: Enhancing mammography referral in primary care.
abstract: BACKGROUND
  This 1-year randomized trial tested the efficacy of behavioral techniques for increasing mammography referrals by primary care physicians in small, community practices.
  
  
  METHODS
  Sixty-one practices were randomly assigned to one of three conditions: (1) education-only control, (2) education plus cue enhancement using mammography chart stickers, and (3) education plus cue enhancement plus feedback and token rewards. Quarterly chart audits of a defined sample (N = 11,716) of women patients 50 years of age or older were conducted to document mammography referrals, completions, and compliance.
  
  
  RESULTS
  Referral and completion rates increased from baseline to first quarter and gradually declined thereafter. Overall, these rates were higher in the cuing conditions than in the control condition. In contrast, compliance rates in both experimental conditions increased over the year while remaining static in the control condition, demonstrating a strong and continuing effect for cue enhancement. Compliance increases were greatest for physicians who were older, nonwhite, with a second speciality, in solo practice, not members of the AMA, not residency trained, and not board certified.
  
  
  CONCLUSIONS
  Chart stickers can significantly increase mammography utilization in small, community practices. These practices are an efficient route to reaching large numbers of older women in need of mammography screening.
authors.affiliation: Massachusetts Institute of Behavioral Medicine, Inc., East Longmeadow, Massachusetts 01028, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Grady
authors.forename: J P
authors.initials: JP
authors.lastname: Lemkau
authors.forename: N R
authors.initials: NR
authors.lastname: Lee
authors.forename: C
authors.initials: C
authors.lastname: Caddell
mesh_terms: D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data*; D008485:Medical Audit; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards*; D017010:Reminder Systems / Q000592:standards*; D012201:Reward