A national survey of primary care physicians' methods for screening for fecal occult blood
A national survey of primary care physicians' methods for screening for fecal occult blood
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DOI：
10.7326/0003-4819-142-2-200501180-00007
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发表时间：
2005-01-18
影响因子：
39.2
通讯作者：
Ransohoff, DF
中科院分区：
文献类型：
--
作者：
Nadel, MR;Shapiro, JA;Ransohoff, DF
工作背景：在随机对照试验中，粪便潜血试验（FOBT）筛查已被证明可降低结直肠癌的发病率和死亡率。虽然测试是简单的，实施需要坚持特定的技术测试和后续的异常results.Objective：研究如何FOBT和后续进行的社区实践横跨美国。设计：横截面全国调查的初级保健医生和公众。设置：卫生保健机构结直肠癌筛查实践调查和2000年国民健康访谈调查。参与者：1147名初级保健医生订购或执行FOBT和11365名50岁或以上的成年人回答有关FOBT使用的问题。测量：关于FOBT实施细节和积极结果随访的自我报告数据。结果：尽管筛查指南建议进行家庭检测，但32.5%（95% CI，29.8%至35.3%）的医生仅使用了准确度较低的单样本办公室检测方法;另有41.2%（CI，38.3%至44.0%）的医生使用了两种类型的检测。对阳性检测结果的随访显示，相当多的人不遵守指南，29.7%（CI，27.1%至32.4%）的医生建议重复FOBT。此外，乙状结肠镜检查，而不是全结肠检查，通常建议工作的异常结果。近三分之一的报告有FOBT的成年人说他们只有一个办公室测试，近三分之一的报告异常FOBT结果的人报告没有后续诊断程序。局限性：该研究是基于自我报告。从全国健康访谈调查的数据可能会低估的患病率在办公室测试和不充分的后续upson.Conclusions：死亡率降低与FOBT在临床试验中表现出可能无法实现在社区实践中，因为常见的使用在办公室测试和不适当的后续积极的结果。需要对提供者进行教育和系统一级的干预，以提高筛查实施的质量。
Background: Screening with the fecal occult blood test (FOBT) has been shown to reduce colorectal cancer incidence and mortality in randomized, controlled trials. Although the test is simple, implementation requires adherence to specific techniques of testing and follow-up of abnormal results.Objective: To examine how FOBT and follow-up are conducted in community practice across the United States.Design: Cross-sectional national surveys of primary care physicians and the public.Setting: The Survey of Colorectal Cancer Screening Practices in Health Care Organizations and the 2000 National Health Interview Survey.Participants: 1147 primary care physicians who ordered or performed FOBT and 11 365 adults 50 years of age or older who responded to questions about FOBT use.Measurements: Self-reported data on details of FOBT implementation and follow-up of positive results.Results: Although screening guidelines recommend home tests, 32.5% (95% Cl, 29.8% to 35.3%) of physicians used only the less accurate method of single-sample in-office testing; another 41.2% (Cl, 38.3% to 44.0%) used both types of test. Follow-up of positive test results showed considerable nonadherence to guidelines, with 29.7% (Cl, 27.1% to 32.4%) of physicians recommending repeating FOBT. Furthermore, sigmoidoscopy, rather than total colon examination, was commonly recommended to work up abnormal findings. Nearly one third of adults who reported having FOBT said they had only an in-office test, and nearly one third of those who reported abnormal FOBT results reported no follow-up diagnostic procedures.Limitations: The study was based on self-reports. Data from the National Health Interview Survey may underestimate the prevalence of in-office testing and inadequate follow-up.Conclusions: mortality reductions demonstrated with FOBT in clinical trials may not be realized in community practice because of the common use of in-office tests and inappropriate follow-up of positive results. Education of providers and system-level interventions are needed to improve the quality of screening implementation.