Address correspondence to Christopher B. Forrest, M.D., Ph.D., Associate Professor, Departments of Health Policy and Management and Pediatrics, Johns Hopkins Medical Institutions, 624 North Broadway, Room 689, Baltimore, MD 21205. Karen M. Rappaport, is an M.D., Ph.D. Neil A. Holtzman, M.D., M.P.H., is Professor Emeritus, Departments of Pediatrics, Epidemiology, and Health Policy and Management, Johns Hopkins Medical Institutions, Genetics and Public Policy Studies, Baltimore.
Adoption of Liquid-Based Cervical Cancer Screening Tests by Family Physicians and Gynecologists
Article first published online: 28 JUN 2004
Health Services Research
Volume 39, Issue 4p1, pages 927–948, August 2004
How to Cite
Rappaport, K. M., Forrest, C. B. and Holtzman, N. A. (2004), Adoption of Liquid-Based Cervical Cancer Screening Tests by Family Physicians and Gynecologists. Health Services Research, 39: 927–948. doi: 10.1111/j.1475-6773.2004.00265.x
Dr. Rappaport was supported by a NRSA training grant (T32 HS00029) from the Agency for Healthcare research and Quality. Dr. Forrest was funded in part by an Independent Scientist Award from the Agency for Healthcare Research and Quality (K02 HS00003). Funds for physician financial incentives, used to enhance response rate, were obtained from an award made by the Johns Hopkins Bloomberg School of Public Health to Dr. Rappaport.
- Issue published online: 28 JUN 2004
- Article first published online: 28 JUN 2004
- Cervical cancer screening tests;
- family physicians;
- medical decision making
Objective. To examine reasons for the adoption of liquid-based cervical cancer screening tests.
Data Sources/Study Setting. A mailed survey of 250 family physicians and 250 gynecologists in Maryland in 2000. Additional data were obtained from the AMA Master File of Physicians.
Study Design. Key outcome variables in this cross-sectional survey were early adoption of a liquid-based test by the end of 1997 and overall adoption by the time of the survey. Adoption was viewed in terms of a supply and demand theoretical framework with marketing influencing physician and patient demand as well as supply by insurance companies and laboratories.
Data Collection. Random samples of family physicians and gynecologists were selected from the AMA Master File of Physicians. The overall response rate was 61.9 percent.
Principal Findings. By 2000, 96 percent of gynecologists and 75 percent of family physicians in Maryland were using liquid-based cervical cancer screening tests, most commonly the ThinPrep® Pap Test™. Gynecologists were more likely than family physicians to have been early adopters (34 percent versus 5 percent, p<.01). Part of this variation in adoption was due to aggressive marketing to gynecologists, who were more likely than family physicians to receive information in the mail from the test manufacturer (89 percent versus 56 percent, p<.01) and to have been informed by the manufacturer that a patient had inquired about physicians' use of the test (22 percent versus 8 percent, p<.01).
Conclusions. The rapid diffusion of liquid-based cervical cancer screening tests occurred despite general agreement that the Pap smear has been one of the most successful cancer prevention interventions ever. Commercial marketing campaigns appear to contribute to the more rapid rate of diffusion of technology among specialists compared with generalists.