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Gastroenterology. 2019 Oct 31. pii: S0016-5085(19)41480-7. doi: 10.1053/j.gastro.2019.10.027. [Epub ahead of print]

Uptake of Colorectal Cancer Screening by Physicians is Associated With Greater Uptake by Their Patients.

Author information

1
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
2
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Institute for Clinical Evaluative Sciences, ON, Canada.
3
Institute for Clinical Evaluative Sciences, ON, Canada.
4
Institute for Clinical Evaluative Sciences, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
5
Institute for Clinical Evaluative Sciences, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
6
Institute for Clinical Evaluative Sciences, ON, Canada; Division of General Surgery, Department of Surgery, Western University, London, ON, Canada.
7
Institute for Clinical Evaluative Sciences, ON, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
8
Institute for Clinical Evaluative Sciences, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
9
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Institute for Clinical Evaluative Sciences, ON, Canada; Division of Urology, Department of Surgery, Western University, London, ON, Canada.
10
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Institute for Clinical Evaluative Sciences, ON, Canada; Department of Medicine, Western University, London, ON, Canada. Electronic address: Amit.Garg@lhsc.on.ca.

Abstract

BACKGROUND & AIMS:

Physicians' own screening practices might affect screening in their patients. We conducted a population-based study to evaluate whether family physicians who underwent colorectal cancer testing were more likely to have patients who underwent colorectal cancer testing.

METHODS:

We collected demographic and healthcare information on residents of Ontario, Canada from administrative databases; the sample was restricted to individuals at average risk of colorectal cancer who were 52-74 years old as of April 21, 2016. We obtained a list of all registered physicians in the province; physicians (n=11,434) were matched with non-physicians (n=45,736) on age, sex, and residential location. Uptake of colorectal tests was defined by a record of a fecal occult blood test in the past 2 years, flexible sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years. Patients were assigned to family physicians based on billing claim frequency, and then the association between colorectal testing in family physicians and their patients was examined using a modified Poisson regression model.

RESULTS:

Uptake of colorectal tests by physicians and non-physicians (median age 60; 71% men) was 67.9% (95% CI, 67.0%-68.7%) and 66.6% (95% CI, 66.2%-67.1%), respectively. Physicians were less likely than non-physicians to undergo fecal occult blood testing and were more likely to undergo colonoscopy; prevalence ratios were 0.44 (95% CI, 0.42-0.47) and 1.24 (95% CI, 1.22-1.26), respectively. Uptake of colorectal tests by family physicians was associated with greater uptake by their patients (adjusted prevalence ratio, 1.10; 95% CI, 1.08-1.12).

CONCLUSIONS:

Approximately one third of physicians and non-physicians are overdue for colorectal cancer screening. Patients are more likely to be tested if their family physician has been tested. There is an opportunity for physicians to increase their participation in colorectal cancer screening, which could in turn motivate their patients to undergo screening.

KEYWORDS:

colon cancer; early detection; health promotion; physician health

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