Physician and Patient Factors Associated with Ordering a Colon Evaluation After a Positive Fecal Occult Blood Test

Authors

  • Barbara Turner MD, MSEd,

    Corresponding author
    1. Received from the Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, Pa; Division of Genetic and Preventive Medicine (REM, JG), and Division of Gastroenterology (DW), and Biostatistics Section, Division of Clinical Pharmacology (TH, WWH), Department of Medicine, and Office of Continuing Medical Education (TB), Thomas Jefferson University, Philadelphia, Pa; U.S. Quality Algorithms, Inc. (JG, TR), and formerly with U.S. Quality Algorithms, Inc. (NS), Blue Bell, Pa.
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  • Ronald E. Myers PhD,

    1. Received from the Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, Pa; Division of Genetic and Preventive Medicine (REM, JG), and Division of Gastroenterology (DW), and Biostatistics Section, Division of Clinical Pharmacology (TH, WWH), Department of Medicine, and Office of Continuing Medical Education (TB), Thomas Jefferson University, Philadelphia, Pa; U.S. Quality Algorithms, Inc. (JG, TR), and formerly with U.S. Quality Algorithms, Inc. (NS), Blue Bell, Pa.
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  • Terry Hyslop PhD,

    1. Received from the Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, Pa; Division of Genetic and Preventive Medicine (REM, JG), and Division of Gastroenterology (DW), and Biostatistics Section, Division of Clinical Pharmacology (TH, WWH), Department of Medicine, and Office of Continuing Medical Education (TB), Thomas Jefferson University, Philadelphia, Pa; U.S. Quality Algorithms, Inc. (JG, TR), and formerly with U.S. Quality Algorithms, Inc. (NS), Blue Bell, Pa.
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  • Walter W. Hauck PhD,

    1. Received from the Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, Pa; Division of Genetic and Preventive Medicine (REM, JG), and Division of Gastroenterology (DW), and Biostatistics Section, Division of Clinical Pharmacology (TH, WWH), Department of Medicine, and Office of Continuing Medical Education (TB), Thomas Jefferson University, Philadelphia, Pa; U.S. Quality Algorithms, Inc. (JG, TR), and formerly with U.S. Quality Algorithms, Inc. (NS), Blue Bell, Pa.
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  • David Weinberg MD, MSc,

    1. Received from the Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, Pa; Division of Genetic and Preventive Medicine (REM, JG), and Division of Gastroenterology (DW), and Biostatistics Section, Division of Clinical Pharmacology (TH, WWH), Department of Medicine, and Office of Continuing Medical Education (TB), Thomas Jefferson University, Philadelphia, Pa; U.S. Quality Algorithms, Inc. (JG, TR), and formerly with U.S. Quality Algorithms, Inc. (NS), Blue Bell, Pa.
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  • Timothy Brigham PhD,

    1. Received from the Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, Pa; Division of Genetic and Preventive Medicine (REM, JG), and Division of Gastroenterology (DW), and Biostatistics Section, Division of Clinical Pharmacology (TH, WWH), Department of Medicine, and Office of Continuing Medical Education (TB), Thomas Jefferson University, Philadelphia, Pa; U.S. Quality Algorithms, Inc. (JG, TR), and formerly with U.S. Quality Algorithms, Inc. (NS), Blue Bell, Pa.
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  • James Grana PhD,

    1. Received from the Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, Pa; Division of Genetic and Preventive Medicine (REM, JG), and Division of Gastroenterology (DW), and Biostatistics Section, Division of Clinical Pharmacology (TH, WWH), Department of Medicine, and Office of Continuing Medical Education (TB), Thomas Jefferson University, Philadelphia, Pa; U.S. Quality Algorithms, Inc. (JG, TR), and formerly with U.S. Quality Algorithms, Inc. (NS), Blue Bell, Pa.
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  • Todd Rothermel,

    1. Received from the Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, Pa; Division of Genetic and Preventive Medicine (REM, JG), and Division of Gastroenterology (DW), and Biostatistics Section, Division of Clinical Pharmacology (TH, WWH), Department of Medicine, and Office of Continuing Medical Education (TB), Thomas Jefferson University, Philadelphia, Pa; U.S. Quality Algorithms, Inc. (JG, TR), and formerly with U.S. Quality Algorithms, Inc. (NS), Blue Bell, Pa.
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  • Neil Schlackman MD

    1. Received from the Division of General Internal Medicine (BT), University of Pennsylvania, Philadelphia, Pa; Division of Genetic and Preventive Medicine (REM, JG), and Division of Gastroenterology (DW), and Biostatistics Section, Division of Clinical Pharmacology (TH, WWH), Department of Medicine, and Office of Continuing Medical Education (TB), Thomas Jefferson University, Philadelphia, Pa; U.S. Quality Algorithms, Inc. (JG, TR), and formerly with U.S. Quality Algorithms, Inc. (NS), Blue Bell, Pa.
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Address correspondence and requests for reprints to Dr. Turner: University of Pennsylvania, 1122 Blockley Hall/6021, 423 Guardian Dr., Philadelphia, PA 19104 (e-mail: 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.

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