Colorectal screening after polypectomy: A national survey study of primary care physicians
Colorectal screening after polypectomy: A national survey study of primary care physicians
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DOI：
10.7326/0003-4819-145-9-200611070-00007
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发表时间：
2006-11-07
影响因子：
39.2
通讯作者：
Cooper, Gregory S.
中科院分区：
文献类型：
--
作者：
Boolchand, Vikram;Olds, Gregory;Cooper, Gregory S.
背景：初级保健医生在息肉切除术后进行结肠直肠筛查的建议将影响开放通道系统中结肠镜检查的发生率，这些系统不需要在结肠镜检查前咨询胃肠病学家。目的：确定息肉切除术后初级保健医生的监测建议，并将其与美国结直肠癌多社会工作组的建议进行比较。设计：对医生进行横断面研究。背景：美国。参与者：随机抽取500名美国医师学会医师和500名美国家庭医师学会医师，通过邮件调查获得。测量方法：医生被问及在结肠镜检查中出现以下6项结果后，他们是否会建议对一名没有结直肠癌家族史的55岁男性进行重复结肠镜检查：增生性息肉，1例6mm管状腺瘤，2例6mm管状腺瘤，1例12mm管状绒毛腺瘤，1例12mm管状腺瘤伴局灶性高度不典型增生，无息肉但既往有管状腺瘤。结果：总有效率为57%（568名医生）。在受访者中，48%是内科医生，52%是家庭医生。61%的受访者会在5年或更短时间内检查增生性息肉，71%的受访者会在3年或更短时间内检查单个管状腺瘤，80%的受访者会在3年或更短时间内检查2个管状腺瘤。局限性：结果是基于医生的自我报告实践从临床小插曲，可能不符合实际做法。结论：初级保健医生推荐息肉切除术后结肠镜监测的频率高于实践指南的建议，特别是当结肠镜检查显示增生性息肉或单个小腺瘤时。
Background: Recommendations by primary care physicians for colorectal screening after polypectomy will influence rates of colonoscopy in open-access systems that do not require consultation by a gastroenterologist before colonoscopy.Objective: To determine the surveillance recommendations of primary care physicians after polypectomy and compare them with recommendations from the U.S. Multisociety Task Force on Colorectal Cancer.Design: Cross-sectional study of physicians.Setting: United States.Participants: A random sample of 500 physicians from the American College of Physicians and 500 physicians from the American Academy of Family Physicians, obtained by using a mail survey.Measurements: Physicians were asked when they would recommend repeated colonoscopy for a hypothetical 55-year-old man with no family history of colorectal cancer after the following 6 results on colonoscopy: hyperplastic polyp, one 6-mm tubular adenoma, two 6-mm tubular adenomas, one 12-mm tubulovillous adenoma, one 12-mm tubular adenoma with focal high-grade dysplasia, and no polyp but a previous tubular adenoma.Results: The overall response rate was 57% (568 physicians). Of the respondents, 48% were internists and 52% were family practitioners. Sixty-one percent of respondents would survey a hyperplastic polyp in 5 years or less, 71% would survey a single tubular adenoma in 3 years or less, and 80% would survey 2 tubular adenomas in 3 years or less.Limitations: The results are based on physicians' self-reported practices from clinical vignettes and may not match actual practice.Conclusion: Primary care physicians recommend postpolypectomy colonoscopic surveillance more frequently than is recommended by practice guidelines, especially if the colonoscopy showed a hyperplastic polyp or a single small adenoma.