Primary Care Physicians’ Decisions to Perform Flexible Sigmoidoscopy

Authors

  • James D. Lewis MD, MSCE,

    1. Division of Gastroenterology, Philadelphia, Pa.
    2. Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pa.
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  • David A. Asch MD, MBA,

    1. Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pa.
    2. Division of General Internal Medicine, Philadelphia, Pa.
    3. Leonard Davis Institute of Health Economics, Philadelphia, Pa.
    4. University of Pennsylvania, Philadelphia, Pa, and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pa.
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  • Gregory G. Ginsberg MD,

    1. Division of Gastroenterology, Philadelphia, Pa.
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  • Timothy C. Hoops MD,

    1. Division of Gastroenterology, Philadelphia, Pa.
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  • Michael L. Kochman MD,

    1. Division of Gastroenterology, Philadelphia, Pa.
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  • Warren B. Bilker PhD,

    1. Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pa.
    2. Department of Biostatistics and Epidemiology, Philadelphia, Pa.
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  • Brian L. Strom MD, MPH

    1. Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pa.
    2. Division of General Internal Medicine, Philadelphia, Pa.
    3. Leonard Davis Institute of Health Economics, Philadelphia, Pa.
    4. Department of Biostatistics and Epidemiology, Philadelphia, Pa.
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Address correspondence and reprint requests to Dr. Lewis: University of Pennsylvania, Center for Clinical Epidemiology and Biostatistics, 8th Floor, Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104.

Abstract

OBJECTIVE: This study was designed to identify factors that influence primary care physicians’ willingness to perform flexible sigmoidoscopy.

MEASUREMENTS: Using a mailed questionnaire, we surveyed all 161 primary care physicians participating in a large health care system. We obtained information on training, current practice patterns, beliefs about screening for colorectal cancer, and the influence of various factors on their decision whether or not to perform flexible sigmoidoscopy in practice.

MAIN RESULTS: Of the 131 physicians included in the analysis, 68 (52%) reported training in flexible sigmoidoscopy, of whom 36 (53%) were currently performing flexible sigmoidoscopy in practice. Time required to perform flexible sigmoidoscopy, availability of adequately trained staff, and availability of flexible sigmoidoscopy services provided by other clinicians were identified most often as reasons not to perform the procedure in practice. Male physicians were more likely than female physicians to report either performing flexible sigmoidoscopy or desiring to train to perform flexible sigmoidoscopy (odds ratio 2.61; 95% confidence interval 1.10, 6.23). This observed difference appears to be mediated through different weighting of decision criteria by male and female physicians.

CONCLUSIONS: Approximately half of these primary care physicians trained in flexible sigmoidoscopy chose not to perform this procedure in practice. Self-perceived inefficiency in performing office-based flexible sigmoidoscopy deterred many of these physicians from providing this service for their patients.

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