Influence of Primary Care Use on Population Delivery of Colorectal Cancer Screening
Influence of Primary Care Use on Population Delivery of Colorectal Cancer Screening
复制标题
DOI：
10.1158/1055-9965.epi-08-0765
复制
发表时间：
2009-02-01
影响因子：
3.8
通讯作者：
Franks, Peter
中科院分区：
文献类型：
--
作者：
Fenton, Joshua J.;Reid, Robert J.;Franks, Peter
目的：结直肠癌（CRC）筛查通常在初级保健访问期间启动。因此，在人口水平上，有限的初级保健护理可能构成CRC筛查吸收的实质性障碍。在一个确定的人群中，我们量化了CRC筛查未充分使用的百分比，这可能是由于初级保健就诊率低。方法：在华盛顿州健康计划中有资格接受CRC筛查的48，712名年龄在50至78岁之间的成年人中，我们估计了2002年至2003年缺乏CRC筛查的程度。（粪便潜血试验，乙状结肠镜检查，或结肠镜检查）可归因于低初级保健的使用，表示为人口归因风险百分比（PAR%）与0至3初级保健访问在2年期间。在调整了年龄、合并症、非初级保健就诊和既往预防服务使用的分析中，2002 - 2003年初级保健使用率低与女性和男性缺乏CRC筛查密切相关。然而，大多数未经筛查的妇女和男子有≥ 4次初级保健就诊。因此，无论低初级保健使用被定义为0，0至1，0至2，或0至3次初级保健访问，PAR%与低初级保健使用相关的都不是很大的妇女（范围：3.0-6.8%）（范围：5.6-11.5%）。健康计划外展工作，以鼓励初级保健出席将不太可能大幅增加人口接受CRC筛查。在类似的情况下，资源可能会更有成效地致力于优化筛选交付在初级保健访问期间，病人已经参加。（肿瘤表皮生物标志物Prev 20091-18（2）：640-5）
Objective: Colorectal cancer (CRC) screening is commonly initiated during primary care visits. Thus, at the population level, limited primary care attendance may constitute a substantial barrier to CRC screening uptake. Within a defined population, we quantified the percent of CRC screening underuse that is potentially explained by low use of primary care visits.Methods: Among 48,712 adults ages 50 to 78 years eligible for CRC screening within a Washington state health plan, we estimated the degree to which a lack of CRC screening in 2002 to 2003 (fecal occult blood testing, sigmoidoscopy, or colonoscopy) was attributable to low primary care use, expressed as the population attributable risk percent (PAR%) associated with 0 to 3 primary care visits during the 2-year period.Results: In analyses adjusted for age, comorbidity, nonprimary care visit use, and prior preventive service use, low primary care use in 2002 to 2003 was strongly associated with a lack of CRC screening among both women and men. However, a majority of unscreened women and men had >= 4 primary care visits. Thus, whether low primary care use was defined as 0, 0 to 1, 0 to 2, or 0 to 3 primary care visits, the PAR% associated with low primary care use was large in neither women (range, 3.0-6.8%) nor men (range: 5.6-11.5%).Conclusions: Health plan outreach efforts to encourage primary care attendance would be unlikely to substantially increase population uptake of CRC screening. In similar settings, resources might be more fruitfully devoted to the optimization of screening delivery during primary care visits that patients already attend. (Cancer Epidermiol Biomarkers Prev 20091-18(2):640-5)