title: Improving access to mammograms through community-based influenza clinics. A quasi-experimental study.
abstract: BACKGROUND
  It is a national priority to increase breast-cancer screening among women aged > or = 50. Annual influenza clinics may represent an efficient setting in which to promote breast-cancer screening among older women. To our knowledge, this possibility has not previously been explored.
  
  
  OBJECTIVE
  To examine whether offering women attending community-based influenza clinics the opportunity to receive a scheduling telephone call from a mammography facility will result in an increase in the number of mammograms performed over a 6-month period.
  
  
  METHODS
  We used a quasi-experimental design with 6-month follow-up. A contemporaneous population-based survey provided a further control group for comparison. The sample group consisted of a total of 284 women attending nine community-based influenza clinics in a semirural county in Connecticut. All women were aged > or = 50 and reported no mammogram in the preceding 12 months. All women received informational literature on mammography. Experimental subjects were each asked if a radiology facility chosen by the subject could call her at home to schedule a mammogram. Mammograms performed were determined by hospital record for participants who received a scheduling call from a radiology facility, and by self-report for all other participants.
  
  
  RESULTS
  Mammography use following access through influenza clinics was approximately twice that of women attending influenza clinics where access to mammography was not offered. Using three different assumptions regarding participants whose mammography status was unknown, the relative risks ranged between 1.6 and 2.1. For each assumption the results were statistically significant (chi(2)=8.51-12.2; p<0.001).
  
  
  CONCLUSIONS
  Linking access to mammography at community-based influenza clinics can significantly increase the use of mammograms among women aged > or = 50. Further studies should seek to confirm these findings and determine the degree to which they can be replicated in a variety of communities. Enhancing preventive health practice through the bundling of services suggests a new strategy to exploit available interventions to improve health.
authors.affiliation: Sickness Prevention Achieved through Regional Collaboration (SPARC), Lakeville, Connecticut, USA. dshenson@channell.com
authors.forename: D
authors.initials: D
authors.lastname: Shenson
authors.forename: L
authors.initials: L
authors.lastname: Cassarino
authors.forename: D
authors.initials: D
authors.lastname: DiMartino
authors.forename: P
authors.initials: P
authors.lastname: Marantz
authors.forename: J
authors.initials: J
authors.lastname: Bolen
authors.forename: B
authors.initials: B
authors.lastname: Good
authors.forename: M
authors.initials: M
authors.lastname: Alderman
mesh_terms: D003153:Community Health Services; D003237:Connecticut; D005260:Female; D006293:Health Promotion; D006297:Health Services Accessibility; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged