title: A systems model of clinical preventive care: the case of breast cancer screening among older women. For the NCI Breast Cancer Screening Consortium.
abstract: BACKGROUND
  In older women covered by Medicare, relationships among physician recommendation, mammography in the past 2 years, and clinical breast examination (CBE) in the past year were systematically explored with a variety of predisposing, enabling, and situational factors identified in the Systems Model of Clinical Preventive Care.
  
  
  METHODS
  A population-based survey of women age 65 years and older was conducted in five National Cancer Institute's Breast Cancer Screening Consortium geographic areas. Analyses focused on women with a regular physician and site of care (n = 5318).
  
  
  RESULTS
  Physician recommendation and mammography use declined with women's increasing age and increased with income, education, and insurance. CBE and mammography increased with number of physicians and breast cancer family history; mammography use decreased with worsening health status. Recommendations were higher among physicians who were younger, female, and internists. Family practitioners were older and male; women who saw family practitioners reported characteristics associated with decreased screening-lower income, education, and insurance-and seeing only one physician.
  
  
  CONCLUSIONS
  Public policy and health system changes that create a uniform system of finance and service performance expectations may reduce the persistent discrepancy in physician recommendation and mammography use due to sociodemographics and physician specialty.
authors.affiliation: Department of Preventive Medicine, School of Medicine, SUNY at Stony Brook, Stony Brook, New York 11794-8036, USA. dlane@dean.som.sunysb.edu
authors.forename: D S
authors.initials: DS
authors.lastname: Lane
authors.forename: J
authors.initials: J
authors.lastname: Zapka
authors.forename: N
authors.initials: N
authors.lastname: Breen
authors.forename: C R
authors.initials: CR
authors.lastname: Messina
authors.forename: D J
authors.initials: DJ
authors.lastname: Fotheringham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005194:Family Practice; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'; D012959:Socioeconomic Factors