Colorectal carcinoma screening procedure use among primary care patients
Colorectal carcinoma screening procedure use among primary care patients
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DOI：
10.1002/cncr.21333
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发表时间：
2005-10-01
期刊：
影响因子：
6.2
通讯作者：
Divine, G
中科院分区：
文献类型：
--
作者：
Lafata, JE;Williams, LK;Divine, G
背景。尽管针对结直肠癌筛查提出了基于证据的建议，但基于人群的调查报告筛查率较低。据作者所知，初级保健患者使用筛查程序的程度尚不清楚。作者估计了一组初级保健患者每年和 5 年结直肠癌筛查程序的使用情况，并评估了患者特征与筛查程序使用之间的相关性。方法。作者确定了一组年龄为 55-70 岁的患者（n = 21,833 名患者），他们在 2003 年进行过初级保健就诊，并参加了截至 2003 年 12 月 31 日的 5 年期间的健康计划。使用截至 2003 年 12 月 31 日的 5 年期间的自动化数据，有关患者社会人口特征、初级保健和健康维护检查 (HME) 就诊、合并症诊断的信息，收入，并编制筛选收据。后者包括钡剂灌肠、结肠镜检查、粪便潜血测试 (FOBT) 和柔性乙状结肠镜检查的使用。 结果。在 5 年观察期内，大约一半的参保初级保健患者 (54%) 接受了推荐的结直肠癌筛查程序。在接受筛查的个体中，结肠镜检查使用最频繁（39.9%），其次是单独进行柔性乙状结肠镜检查（28.3%）或与 FOBT 相结合（4.3%）。 1999 年至 2003 年间，年度筛查率增加了 3.1%。在未接受推荐的结直肠癌筛查的个体中，64% 的人至少接受过 3 次 HME 就诊，41% 的人至少接受过 1 次 FOBT。 HME 就诊和其他初级保健就诊频率的增加，以及年龄、收入、男性性别和非裔美国人种族的增加，都与筛查接收相关。结论。存在着增加初级保健患者结直肠癌筛查的重大机会。
BACKGROUND. Despite evidence-based recommendations for colorectal carcinoma screening, population-based surveys report low screening rates. To the authors' knowledge, the extent to which screening procedures are used by patients seen in primary care is not as clear. The authors estimated the annual and 5-year colorectal carcinoma screening procedure use among a cohort of primary care patients and evaluated the correlation between patient characteristics and the use of screening procedures.METHODS. The authors identified a cohort of patients (n = 21,833 patients) ages 55-70 years who had a primary care visit in 2003 and who were enrolled in a health plan for the 5-year period ending December 31, 2003. Using automated data for the 5-year period ending December 31, 2003, information on patient sociodemo graphic characteristics, primary care and health maintenance examination (HME) visits, comorbid diagnoses, income, and screening receipt was compiled. The latter included barium enema, colonoscopy, fecal occult blood testing (FOBT), and flexible sigmoidoscopy use.RESULTS. Approximately one-half of insured, primary care patients (54%) received recommended colorectal carcinoma screening procedures over the 5-year observation period. Among individuals who received screening, colonoscopy was used most frequently (39.9%), followed by flexible sigmoidoscopy testing alone (28.3%) or in combination with FOBT (4.3%). Annual screening rates increased by 3.1% between 1999 and 2003. Among individuals who did not receive recommended colorectal carcinoma screening, 64% had at least 3 HME visits, and 41% received at least 1 FOBT. Increasing HME visits and other primary care visit frequency, along with increasing age, income, male gender, and African-American race, were associated with screening receipt.CONCLUSIONS. Significant opportunities exist to increase colorectal carcinoma screening among primary care patients.