The fact that the relationship between the referring and receiving office can have a major impact on the frequency and type of referrals may come as a surprise to those not involved in the process.
Which begs the question; Do the same social factors affect public screening programs?
It is easy to find articles which identify socioeconomic factors that affect the likelihood of public screening. It is not very easy to find articles which evaluate the business savvy of the screening program.
For instance, if referrals are made by fax for routine mammography and the clinic will only call the patient once then never call back the screening rate will lower. The same holds true if referring offices frequently get busy signals. Catchment area analysis would pick up the problem but only if someone takes the time to use it.
I know in our own practice that ease of referral is a major predictor who generalists utilize. I wonder whether the same holds true for public screening programs.