What Factors are Associated with Where Women Undergo Clinical Breast Examination? Results from the 2005 National Health Interview Survey.

BACKGROUND Recent studies have suggested that clinical breast examination (CBE) rates may vary according to patient, provider and health care system characteristics. OBJECTIVE To examine the locations where U.S. women received a CBE and other general preventive health, and to examine predictors of location of receipt of general preventive health care (including a recent CBE). DESIGN Age-specific and age-adjusted rates of CBE use were calculated using Statistical Analysis Software (SAS) and SUDAAN. A multivariate analysis was carried out using logistic regression techniques. PARTICIPANTS Women aged 40 years and older (n = 10,002) who participated in the 2005 National Health Interview Survey (NHIS). MEASUREMENTS Recent CBE use was defined as within the past two years. RESULTS Among all women, 65% reported a CBE within two years. The highest rate was found among women receiving routine care from doctors' offices and health maintenance organizations (HMOs) (68.5%). CBE use was somewhat lower among women receiving routine care from clinics or health centers (62.9%), and substantially lower among women receiving care from "other" locations (28.4%) or not reporting receiving preventive care (25.3%). Low income women (p < .01) and those with less than a high school education (p < .01) are more likely to go to a hospital than higher SES women. Women with health insurance are much more likely than women without health insurance to go to a doctor's office or HMO, and less likely to be seen at a clinic or health center (p < .01 in both instances). In multivariate analysis, women who received routine care in a location other than a clinic or health center, doctor's office or HMO, or hospital outpatient department (OPD) were less likely to have received a CBE within the past two years (adjusted OR = 0.4, 95% CI = 0.3, 0.7) compared to those at a doctor's office or HMO. CONCLUSIONS After adjusting for patient factors, clinics/health centers and hospital OPDs performed as well as doctors' offices/HMOs in delivering CBE. However, women receiving care in other locations were less likely to report CBE.