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Primary care provider perceptions of barriers to and facilitators of colorectal cancer screening in a managed care setting

  1. Gareth S. Dulai M.D., M.S.H.S.1,2,3,*,
  2. Melissa M. Farmer Ph.D.4,5,
  3. Patricia A. Ganz M.D.3,4,5,
  4. Coen A. Bernaards Ph.D.4,6,
  5. Karen Qi M.S.4,
  6. Allen J. Dietrich M.D.7,
  7. Roshan Bastani Ph.D.4,5,
  8. Michael J. Belman M.D., M.P.H.8,†,
  9. Katherine L. Kahn M.D.3,9,10

Article first published online: 22 MAR 2004

DOI: 10.1002/cncr.20209

Issue

Cancer

Cancer

Volume 100, Issue 9, pages 1843–1852, 1 May 2004

Additional Information

How to Cite

Dulai, G. S., Farmer, M. M., Ganz, P. A., Bernaards, C. A., Qi, K., Dietrich, A. J., Bastani, R., Belman, M. J. and Kahn, K. L. (2004), Primary care provider perceptions of barriers to and facilitators of colorectal cancer screening in a managed care setting. Cancer, 100: 1843–1852. doi: 10.1002/cncr.20209

Author Information

  1. 1

    Division of Gastroenterology, Center for Ulcer Research and Education Digestive Diseases Research Center, Greater Los Angeles Veterans Administration Healthcare System, Los Angeles, California

  2. 2

    Center for the Study of Digestive Healthcare Quality and Outcomes, University of California–Los Angeles Center for Neurovisceral Sciences and Women's Health, Los Angeles, California

  3. 3

    Department of Medicine, School of Medicine, University of California–Los Angeles, Los Angeles, California

  4. 4

    Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, School of Public Health, University of California–Los Angeles, Los Angeles, California

  5. 5

    Department of Health Services, School of Public Health, University of California–Los Angeles, Los Angeles, California

  6. 6

    Department of Statistics, University of California–Los Angeles, Los Angeles, California

  7. 7

    Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire

  8. 8

    Blue Cross of California, Woodland Hills, California

  9. 9

    RAND Corporation, Santa Monica, California

  10. 10

    Division of General Internal Medicine, University of California–Los Angeles, Los Angeles, California

  1. †

    Dr. Belman serves as Director of Quality Assurance for Blue Cross of California (Woodland Hills, CA), the institution at which the current study was performed, and he holds stock in Blue Cross of California's parent company (WellPoint, Thousand Oaks, CA).

*Center for the Study of Digestive Healthcare Quality and Outcomes, Greater Los Angeles Veterans Administration Healthcare System, CURE, Building 115, Room 215c, 11301 Wilshire Blvd., Los Angeles, CA 90073;

  1. †

    Dr. Belman serves as Director of Quality Assurance for Blue Cross of California (Woodland Hills, CA), the institution at which the current study was performed, and he holds stock in Blue Cross of California's parent company (WellPoint, Thousand Oaks, CA).

Publication History

  1. Issue published online: 19 APR 2004
  2. Article first published online: 22 MAR 2004
  3. Manuscript Accepted: 18 FEB 2004
  4. Manuscript Revised: 5 FEB 2004
  5. Manuscript Received: 28 JUL 2003

Funded by

  • National Institutes of Health/National Cancer Institute. Grant Number: NIH/NCI RO1 CA75544
  • American Cancer Society Clinical Research Professorship
  • American Digestive Health Foundation
  • Veterans Administration Ambulatory Care Fellowship
  • National Institutes of Health/National Center for Research Resources. Grant Number: NIH/NCRR K23 1618801

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Keywords:

  • screening;
  • managed care;
  • health services research;
  • survey;
  • colorectal cancer

Abstract

BACKGROUND

Colorectal cancer (CRC) screening tests (e.g., fecal occult blood testing [FOBT], flexible sigmoidoscopy [FS], etc.) are underused. Primary care providers (PCPs) play a critical role in screening, but barriers to and facilitators of screening as perceived by PCPs in managed care settings are poorly understood. The objectives of the current study were to describe current CRC screening practices and to explore determinants of test use by PCPs in a managed care setting.

METHODS

In 2000, a self-administered survey was mailed to a stratified, random sample of 1340 PCPs in a large, network model health maintenance organization in California.

RESULTS

The survey response rate was 67%. PCPs indicated that 79% of their standard-risk patients were screened for CRC. PCP-reported median rates of recommendation for the use of specific screening tests were 90% for FOBT and 70% for FS. In logistic regression models, perceived barriers to the use of FOBT and FS included patient characteristics (e.g., education) and PCP-related barriers (e.g., failure to recall that patients were due for testing). Perceived facilitators of the use of FOBT and FS included interventions targeting certain aspects of the health care system (e.g., reimbursement) and interventions targeting certain aspects of the tests themselves (e.g., provision of evidence of a test's effectiveness). Assignment of high priority to screening, integrated medical group (as opposed to independent practice association) affiliation, and the proportion of patients receiving routine health maintenance examinations were positively associated with reported test use.

CONCLUSIONS

CRC screening tests appear to be underused in the managed care setting examined in the current study. The perceived barriers and facilitators that were identified can be used to guide interventions aimed at increasing recommendations for, as well as actual performance of, CRC screening. Cancer 2004. © 2004 American Cancer Society.

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