title: Effectiveness of academic detailing on breast cancer screening among primary care physicians in an underserved community.
abstract: BACKGROUND
  Urban minority groups, such as those living in northern Manhattan and the South Bronx, are generally underserved with regard to breast cancer prevention and screening practices. Primary care physicians are critical for the recommendation of mammography and clinical breast examinations to their patients.
  
  
  METHODS
  Two medically underserved communities were matched and block randomized. The aim of the study was to assess the efficacy of academic detailing in increasing recommendations for breast cancer screening in community-based primary care physicians.
  
  
  METHODS
  Ninety-four primary care community-based (ie, not hospital-based) physicians in northern Manhattan were compared with 74 physicians in the South Bronx who received no intervention.
  
  
  METHODS
  INTERVENTION participants received multicomponent physician-directed education, academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer.
  
  
  METHODS
  We administered interviews to ask about primary care physicians' recommendation of mammography and clinical breast examination. They were also queried about their knowledge of major risk factors and perceived barriers to breast cancer screening. We conducted medical audits of 710 medical charts 2 years before and after the intervention.
  
  
  RESULTS
  Using a mixed models linear analysis, we found a statistically significant intervention effect on the recommendation of mammography and clinical breast examination (according to medical audit) by female patients age 40 and over. INTERVENTION group physicians correctly identified significantly more risk factors for breast cancer, and significantly fewer barriers to practice, than did comparison physicians.
  
  
  CONCLUSIONS
  We found some evidence of improvement in breast cancer screening practices due to academic detailing among primary care physicians practicing in urban underserved communities.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, NY 10027, USA. ssg19@columbia.edu
authors.forename: Sherri Sheinfeld
authors.initials: SS
authors.lastname: Gorin
authors.forename: Alfred R
authors.initials: AR
authors.lastname: Ashford
authors.forename: Rafael
authors.initials: R
authors.lastname: Lantigua
authors.forename: Ashfaque
authors.initials: A
authors.lastname: Hossain
authors.forename: Manisha
authors.initials: M
authors.lastname: Desai
authors.forename: Andrea
authors.initials: A
authors.lastname: Troxel
authors.forename: Donald
authors.initials: D
authors.lastname: Gemson
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007400:Interprofessional Relations; D016014:Linear Models; D008403:Mass Screening / Q000706:statistics & numerical data*; D008485:Medical Audit; D008507:Medically Underserved Area; D008875:Middle Aged; D008913:Minority Groups; D015999:Multivariate Analysis; D009519:New York City; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards; D014505:Urban Population