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J Gen Intern Med. 2003 May;18(5):357-63.

Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test.

Author information

1
Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, PA, USA. bturner@mail.med.upenn.edu

Abstract

OBJECTIVE:

Successful colorectal cancer screening relies in part on physicians ordering a complete diagnostic evaluation of the colon (CDE) with colonoscopy or barium enema plus sigmoidoscopy after a positive screening fecal occult blood test (FOBT).

DESIGN:

We surveyed primary care physicians about colorectal cancer screening practices, beliefs, and intentions. At least 1 physician responded in 318 of 413 (77%) primary care practices that were affiliated with a managed care organization offering a mailed FOBT program for patients aged >/=50 years. Of these 318 practices, 212 (67%) had 602 FOBT+ patients from August through November 1998. We studied 184 (87%) of these 212 practices with 490 FOBT+ patients after excluding those judged ineligible for a CDE or without demographic data. Three months after notification of the FOBT+ result, physicians were asked on audit forms if they had ordered CDEs for study patients. Patient- and physician-predictors of ordering CDEs were identified using logistic regression.

MEASUREMENTS AND MAIN RESULTS:

A CDE was ordered for only 69.5% of 490 FOBT+ patients. After adjustment, women were less likely to have had CDE initiated than men (adjusted odds, 0.66; confidence interval, 0.44 to 0.97). Physician survey responses indicating intermediate or high intention to evaluate a FOBT+ patient with a CDE were associated with nearly 2-fold greater adjusted odds of actually initiating a CDE in this circumstance versus physicians with a low intention.

CONCLUSIONS:

Primary care physicians often fail to order CDE for FOBT+ patients. A CDE was less likely to be ordered for women and was influenced by physician's beliefs about CDEs.

Comment in

PMID:
12795734
PMCID:
PMC1494867
DOI:
10.1046/j.1525-1497.2003.20525.x
[Indexed for MEDLINE]
Free PMC Article

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