An Analysis of Lung Cancer Screening Beliefs and Practice Patterns for Community Providers Compared to Academic Providers.
An Analysis of Lung Cancer Screening Beliefs and Practice Patterns for Community Providers Compared to Academic Providers.
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DOI：
10.1177/1073274818806900
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Nair VS
中科院分区：
文献类型：
--
作者：
Khairy M;Duong DK;Shariff-Marco S;Cheng I;Jain J;Balakrishnan A;Liu L;Gupta A;Chandramouli R;Hsing A;Leung A;Singh B;Nair VS
尽管指南建议每年对肺癌进行低剂量计算机断层扫描（LDCT）筛查，但由于启动和维持临床项目的复杂性，接受率仍然很低——在服务不足的人群中，问题可能会扩大。我们对加州圣克拉拉县联邦合格医疗中心（fqhc）的社区医疗服务提供者进行了一项调查，以评估影响依从性的医疗服务提供者相关因素。然后，我们将这些发现与同一县的学术转诊中心的学术提供者（APs）的LDCT筛查知识、行为和态度进行了比较。4个fqhc为8万名患者登记了医疗服务，其中大部分是少数民族血统，并由Medi-Cal保险。在75家FQHC提供者（FQHCPs）中，36家（48%）完成了调查。在36个提供者中，8个（22%）知道筛查标准。15名（42%）FQHCPs与患者讨论了LDCT筛查。与36名ap相比，FQHCPs更关注危害、假阳性、讨论时间、患者冷漠、保险覆盖范围以及缺乏筛查和随访的专业知识。然而，与APs相比，更多的FQHCPs认为筛查是有效的（27 [75%]/ 36）（P = 0.0003）。总之，与学术机构相比，社区诊所为服务不足的人群提供服务时，提供者的知识差距更大，障碍也不同，但存在切实可行且可扩展的解决方案，以提高采用率。
Despite guidelines recommending annual low-dose computed tomography (LDCT) screening for lung cancer, uptake remains low due to the perceived complexity of initiating and maintaining a clinical program—problems that likely magnify in underserved populations. We conducted a survey of community providers at Federally Qualified Health Centers (FQHCs) in Santa Clara County, California, to evaluate provider-related factors that affect adherence. We then compared these findings to academic providers’ (APs) LDCT screening knowledge, behaviors, and attitudes at an academic referral center in the same county. The 4 FQHCs enrolled care for 80 000 patients largely of minority descent and insured by Medi-Cal. Of the 75 FQHC providers (FQHCPs), 36 (48%) completed the survey. Of the 36 providers, 8 (22%) knew screening criteria. Fifteen (42%) FQHCPs discussed LDCT screening with patients. Compared to 36 APs, FQHCPs were more concerned about harms, false positives, discussion time, patient apathy, insurance coverage, and a lack of expertise for screening and follow-up. Yet, more FQHCPs thought screening was effective (27 [75%] of 36) compared to APs (P = .0003). In conclusion, provider knowledge gaps are greater and barriers are different for community clinics caring for underserved populations compared to their academic counterparts, but practical and scalable solutions exist to enhance adoption.
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