Physician and Patient Factors Associated with Ordering a Colon Evaluation After a Positive Fecal Occult Blood Test
Article first published online: 10 JUN 2003
Journal of General Internal Medicine
Volume 18, Issue 5, pages 357–363, May 2003
How to Cite
Turner, B., Myers, R. E., Hyslop, T., Hauck, W. W., Weinberg, D., Brigham, T., Grana, J., Rothermel, T. and Schlackman, N. (2003), Physician and Patient Factors Associated with Ordering a Colon Evaluation After a Positive Fecal Occult Blood Test. Journal of General Internal Medicine, 18: 357–363. doi: 10.1046/j.1525-1497.2003.20525.x
- Issue published online: 10 JUN 2003
- Article first published online: 10 JUN 2003
- colorectal neoplasms;
- primary health care;
- occult blood;
- mass screening;
- attitude of health personnel
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.