title: Variation in screening mammography and Papanicolaou smear by primary care physician specialty and gatekeeper plan (United States).
abstract: OBJECTIVE
  To assess whether the specialty of a patient's primary care physician or being part of a gatekeeper plan influence breast and cervical cancer screening.
  
  
  METHODS
  Cross-sectional study of women in a national sample. For mammography, we studied women aged 40 and above, and for Papanicolaou (Pap) smear, women aged 18-65 years. Screening mammography or Pap smear within the previous two years was measured by patient self-report. The key independent variables were primary care physician specialty and whether the patient had a gatekeeper.
  
  
  RESULTS
  Among women seen by a family practice physician, there was a higher probability of being screened if the patient was part of a gatekeeper plan than if the patient was not part of a gatekeeper plan: mammography (OR = 1.35; 95% CI = 1.20-1.52) and Pap smear (OR = 1.60; 95% CI = 1.34-1.91). Among women seen by an internal medicine physician, cancer screening did not vary significantly by gatekeeper status.
  
  
  CONCLUSIONS
  The impact of gatekeeper plans upon cancer screening varies according to the primary care physician's specialty. Policy interventions designed to increase cancer screening should take into account different responses to gatekeeper requirements among different types of providers.
authors.affiliation: San Francisco General Hospital, Division of General Internal Medicine, University of California, San Francisco. haggstrd@mail.nih.gov
authors.forename: David A
authors.initials: DA
authors.lastname: Haggstrom
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Phillips
authors.forename: Su-Ying
authors.initials: SY
authors.lastname: Liang
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.forename: Sherilyn
authors.initials: S
authors.lastname: Tye
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D006176:Gynecology; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000517:prevention & control; D009819:Office Visits / Q000706:statistics & numerical data; D065006:Papanicolaou Test; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014481:United States; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health