Self-reported colorectal cancer screening of Medicare beneficiaries in family medicine vs. internal medicine practices in the United States: a cross-sectional study

BMC Gastroenterology

Chyke A Doubeni⁴  Jennifer Tjia⁴  Becky Briesacher⁴  Adeyinka O Laiyemo¹  Karon L Phillips²  Anna R B Doubeni³  Angela Y Higgins³ 

[1] Division of Gastroenterology, Department of Medicine, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA;Program on Aging and Care, Scott & White Memorial Hospital, 2401 South 31st. Street, Temple, TX 76508, USA;Department of Family Medicine and Community Health, University of Massachusetts (UMass) Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA;Meyers Primary Care Institute and Division of Geriatrics, UMass Medical School, 377 Plantation Street, Worcester, MA 01605, USA

关键词: Fecal occult blood test;    Colonoscopy;    Primary care physicians;    Colorectal cancer screening;   

Others  :  1113123
DOI  :  10.1186/1471-230X-12-23

 received in 2011-11-30, accepted in 2012-03-21,  发布年份 2012

【 摘 要 】

Background

The benefit of screening for decreasing the risk of death from colorectal cancer (CRC) has been shown, yet many patients in primary care are still not undergoing screening according to guidelines. There are known variations in delivery of preventive health care services among primary care physicians. This study compared self-reported CRC screening rates and patient awareness of the need for CRC screening of patients receiving care from family medicine (FPs) vs. internal medicine (internists) physicians.

Methods

Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey). The main outcome was the percentage of patients screened in 2007. We also examined the percentage of patients offered screening.

Results

Patients of FPs, compared to those of internists, were less likely to have received an FOBT kit or undergone home FOBT, even after accounting for patients' characteristics. Compared to internists, FPs' patients were more likely to have heard of colonoscopy, but were less likely to receive a screening colonoscopy recommendation (18% vs. 27%), or undergo a colonoscopy (43% vs. 46%, adjusted odds ratios [AOR], 95% confidence interval [CI]-- 0.65, 0.51-0.81) or any CRC screening (52% vs. 60%, AOR, CI--0.80, 0.68-0.94). Among subgroups examined, higher income beneficiaries receiving care from internists had the highest screening rate (68%), while disabled beneficiaries receiving care from FPs had the lowest screening rate (34%).

Conclusion

Patients cared for by FPs had a lower rate of screening compared to those cared for by internists, despite equal or higher levels of awareness; a difference that remained statistically significant after accounting for socioeconomic status and access to healthcare. Both groups of patients remained below the national goal of 70 percent.

【 授权许可】

   
2012 Higgins et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F: Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993, 328(19):1365-1371.
• [2]Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, James PD, Mangham CM: Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996, 348(9040):1472-1477.
• [3]Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, Snover DC, Schuman LM: The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 2000, 343(22):1603-1607.
• [4]Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JM, Parkin DM, Wardle J, Duffy SW, Cuzick J: Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010, 375(9726):1624-1633.
• [5]Doubeni CA, Laiyemo AO, Klabunde CN, Young AC, Field TS, Fletcher RH: Racial and ethnic trends of colorectal cancer screening among Medicare enrollees. Am J Prev Med 2010, 38(2):184-191.
• [6]Doubeni CA, Laiyemo AO, Young AC, Klabunde CN, Reed G, Field TS, Fletcher RH: Primary care, economic barriers to health care, and use of colorectal cancer screening tests among Medicare enrollees over time. Ann Fam Med 2010, 8(4):299-307.
• [7]US Department of Health and Human Services Office of Disease Prevention and Health Promotion: Healthy People 2020 2011.
• [8]Klabunde CN, Schenck AP, Davis WW: Barriers to colorectal cancer screening among Medicare consumers. Am J Prev Med 2006, 30(4):313-319.
• [9]Wee CC, McCarthy EP, Phillips RS: Factors associated with colon cancer screening: the role of patient factors and physician counseling. Prev Med 2005, 41(1):23-29.
• [10]Meissner HI, Breen N, Klabunde CN, Vernon SW: Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiol Biomarkers Prev 2006, 15(2):389-394.
• [11]Etzioni DA, Yano EM, Rubenstein LV, Lee ML, Ko CY, Brook RH, Parkerton PH, Asch SM: Measuring the quality of colorectal cancer screening: the importance of follow-up. Dis Colon Rectum 2006, 49(7):1002-1010.
• [12]DeVoe JE, Fryer GE, Phillips R, Green L: Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health 2003, 93(5):786-791.
• [13]Jaen CR, Stange KC, Nutting PA: Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract 1994, 38(2):166-171.
• [14]Bindman AB, Grumbach K, Osmond D, Vranizan K, Stewart AL: Primary care and receipt of preventive services. J Gen Intern Med 1996, 11(5):269-276.
• [15]Noren J, Frazier T, Altman I, DeLozier J: Ambulatory medical care: a comparison of internists and family-general practitioners. N Engl J Med 1980, 302(1):11-16.
• [16]Stafford RS, Saglam D, Causino N, Starfield B, Culpepper L, Marder WD, Blumenthal D: Trends in adult visits to primary care physicians in the United States. Arch Fam Med 1999, 8(1):26-32.
• [17]Ewing GB, Selassie AW, Lopez CH, McCutcheon EP: Self-report of delivery of clinical preventive services by U.S. physicians. Comparing specialty, gender, age, setting of practice, and area of practice. Am J Prev Med 1999, 17(1):62-72.
• [18]Pham HH, Schrag D, Hargraves JL, Bach PB: Delivery of preventive services to older adults by primary care physicians. Jama 2005, 294(4):473-481.
• [19]Adler GS: A profile of the Medicare Current Beneficiary Survey. Health Care Financ Rev 1994, 15(4):153-163.
• [20]Doubeni CA, Laiyemo AO, Reed G, Field TS, Fletcher RH: Socioeconomic and racial patterns of colorectal cancer screening among Medicare enrollees in 2000 to 2005. Cancer Epidemiol Biomarkers Prev 2009, 18(8):2170-2175.
• [21]Use of colorectal cancer tests--United States, 2002, 2004, and 2006 MMWR Morb Mortal Wkly Rep 2008, 57(10):253-258.
• [22]Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M, Kuntz KM: Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2008, 149(9):659-669.
• [23]Doubeni CA, Laiyemo AO, Klabunde CN, Young AC, Field TS, Fletcher RH: Racial and ethnic trends of colorectal cancer screening among Medicare enrollees. Am J Prev Med 2009, 38(2):184-191.
• [24]Shah BR, Hux JE, Laupacis A, Zinman B, Cauch-Dudek K, Booth GL: Administrative data algorithms can describe ambulatory physician utilization. Health Serv Res 2007, 42(4):1783-1796.
• [25]Stange KC, Goodwin MA, Zyzanski SJ, Dietrich AJ: Sustainability of a practice-individualized preventive service delivery intervention. Am J Prev Med 2003, 25(4):296-300.
• [26]Seres KA, Kirkpatrick AC, Tierney WM: The utility of an evidence-based lecture and clinical prompt as methods to improve quality of care in colorectal cancer screening. Am J Gastroenterol 2009, 104(2):420-425.
• [27]Hall HI, Van Den Eeden SK, Tolsma DD, Rardin K, Thompson T, Hughes Sinclair A, Madlon-Kay DJ, Nadel M: Testing for prostate and colorectal cancer: comparison of self-report and medical record audit. Preventive medicine 2004, 39(1):27-35.
• [28]Hiatt RA, Perez-Stable EJ, Quesenberry C Jr, Sabogal F, Otero-Sabogal R, McPhee SJ: Agreement between self-reported early cancer detection practices and medical audits among Hispanic and non-Hispanic white health plan members in northern California. Preventive medicine 1995, 24(3):278-285.
• [29]Gordon NP, Hiatt RA, Lampert DI: Concordance of self-reported data and medical record audit for six cancer screening procedures. Journal of the National Cancer Institute 1993, 85(7):566-570.
• [30]Schenck AP, Klabunde CN, Warren JL, Peacock S, Davis WW, Hawley ST, Pignone M, Ransohoff DF: Data sources for measuring colorectal endoscopy use among Medicare enrollees. Cancer Epidemiol Biomarkers Prev 2007, 16(10):2118-2127.