Improved detection and referral of patients with diabetic retinopathy by primary care physicians: effectiveness of education

Article Abstract:

Although early treatment of diabetic retinopathy, a disorder of the eye's retina that is currently the main cause of new cases of legal blindness, can reduce the probability that severe visual loss will result, many patients with this condition never consult an ophthalmologist until it is too late to save their vision. A survey carried out in 1979 indicated that fewer than one third of family physicians and only 40 percent of internists were aware of the results of an important study of diabetic retinopathy that described the available treatments and their effectiveness. A study was carried out to assess the value of a four-hour training course for physicians who were not eye specialists that focused on the recognition and management of diabetic retinopathy. Ten physicians took part, and 20 patients with various degrees of diabetic retinopathy were presented to them. At the beginning of the course, physicians completed questionnaires to indicate their levels of medical training, the degree of confidence they felt when examining their diabetic patients' eyes, and their knowledge of diabetic retinopathy. The course itself consisted of lecture and slide presentations, written material, and direct ophthalmoscopic examination of the patients. The physicians were encouraged to examine their diabetic patients' eyes for 12 days. At the end of that period, they examined 10 new patients with diabetic retinopathy, and took a second examination. Before the course began, only one physician could correctly name a medication for dilating the pupils, and none performed dilated-eye examinations on diabetic patients. The scores on the written examination increased from 49 to 78 percent correct. The increase in correctness of the physicians' scores of patients' degree of retinopathy was slight but significant. Physicians became less likely to fail to detect retinopathy as a result of taking the course. The study showed that a short course can improve physicians' awareness and ability to manage diabetic retinopathy. The results are particularly important, since this is a disease whose course, with timely treatment, can be dramatically slowed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Study and teaching, Diabetic retinopathy

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The impact of physician compliance on screening mammography for older women

Article Abstract:

Mammography screening for breast cancer among women under 50 years old is somewhat controversial, but for women 50 years old and older, there is general agreement on the efficacy of routine screening. The American Cancer Society (ACS) and the National Cancer Institute (NCI) both support annual screening for women over 50 years. In spite of this, few women have regular mammograms. The older the woman, the less likely she is to have had a screening mammogram. Also, among women in their fifties, 38 percent of white women have had a mammogram, almost 33 percent of Hispanic women have, and just over 27 percent of black women have had one. For all three groups, the proportions are much lower for women over 70. This study surveyed 517 women over 50 years old in Los Angeles to determine the factors that predicted whether a woman was likely to have a mammogram. The ACS objectives include two goals: that 80 percent of women over age 50 will have an annual clinical breast examination, and that they will also have annual mammograms. There is a long way to go before this goal is reached. The survey showed that all groups of women were underscreened, particularly those over age 65. Cost was seldom a factor in the decision to have a mammogram. The most influential factor in the woman's decision was whether her doctor had discussed mammography with her. The data therefore suggest that physicians do not advocate mammography. It may be that physicians perceive that patients over 65 do not have long to live anyway, or that they believe their advice will be rejected, perhaps because of cost or convenience. Breast self-examination is the most commonly advocated form of detection, followed by a clinical breast examination, and finally mammography. But this order should be reversed to maximize the chances of early detection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Aged women, Elderly women

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Screening mammography in clinical practice: a complex activity

Article Abstract:

For women between the ages of 50 and 65, periodic mammography screening reduces mortality from breast cancer by diagnosing it early. However, the complex set of interactions required for a healthy woman to see her physician, undergo mammography, and complete the follow-up, as well as the controversy over the use of mammography for younger women, inconclusive tests, and ''false-positives'' (reporting disease when there is none) interfere with the development of a standard clinical practice. Even women over 50 years old are not routinely offered mammography, and only a small proportion of women are being screened regularly. Educational programs of various types for physicians regarding mammography have not been particularly useful. ''Readiness for change'' and ''willingness to adopt external standards'' vary from one community to another, and are often the reasons why physicians fail to adopt certain recommendations. Physicians' beliefs about the amount of time and effort required of them, and the inconvenience to patients, figure into their decisions. A better understanding of physicians' and patients' perceptions of each other and their relationships, and how this affects frequency of ordering screening tests, will lead to a better understanding of medical preventive practice and more successful interventions. The study by Sarah Fox and colleagues in the January 1991 issue of the Archives of Internal Medicine examines physician compliance with recommendations for mammography. A related question that needs investigation is, What brings about change in medical practices? (Consumer Summary produced by Reliance Medical Information, Inc.)

Women, Women's health, editorial

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