The role of primary care physicians in improving colorectal cancer screening in patients with HIV.
The role of primary care physicians in improving colorectal cancer screening in patients with HIV.
复制标题
初级保健医生在改善艾滋病毒患者结直肠癌筛查方面的作用。
DOI：
10.1007/s11606-012-2010-z
复制
发表时间：
2012
影响因子：
5.7
通讯作者：
Brady,KathleenA
中科院分区：
文献类型：
--
作者：
Momplaisir,Florence;Long,JudithA;Badolato,Gia;Brady,KathleenA
背景HIV阳性患者寿命更长，他们更容易患上非艾滋病定义的恶性肿瘤。对该人群中常规的癌症筛查做法和与癌症筛查相关的因素知之甚少。目的评估1)有任何类型结直肠癌(CRC)筛查的艾滋病毒患者的比例，以及2)是否有初级保健医生(PCP)或在综合保健实践中寻求护理与较高的CRC筛查有关。设计对参加费城医学监测项目(MMP)的艾滋病毒患者进行横断面图提取研究。PARTICIPANTSMMP参与者年龄50岁及以上。MAIN MEASURESCRC筛查定义为在50岁后进行结肠镜检查、乙状结肠镜检、钡灌肠或粪便隐血测试。115例患者有完整的临床记录。大多数人口是男性(71.3%)、黑人/西班牙裔(73.8%)和50岁至59岁(71.3%)。45.2%的患者没有PCP。接受结直肠癌筛查的患者总比例为46.9%。有记录的PCP是唯一与CRC筛查密切相关的因素。患有PCP的患者筛查率为66.7%，而未患PCP的患者筛查率为28.5%(χ2p<； 0.001)。在调整种族、社会经济地位、药物和酗酒因素后，PCP患者接受结直肠癌筛查的几率为4.59(95%可信区间为2.01-10.48，p<； 为0.001)。患者登记参加治疗的实践类型与结直肠癌筛查无关。结论保留PCP显著增加了HIV患者接受结直肠癌筛查的可能性。随着艾滋病毒患者年龄的增长，满足艾滋病毒诊所初级保健需求的能力只会变得更加重要。
BACKGROUNDAs HIV positive patients live longer, they become susceptible to the development of non-AIDS defining malignancies. Little is known about routine cancer screening practices in that population and the factors associated with cancer screening.OBJECTIVEEvaluate 1) the proportion of patients with HIV who had any type of colorectal cancer (CRC) screening and 2) whether having a primary care physician (PCP) or seeking care in an integrated care practice is associated with higher CRC screening.DESIGNA cross-sectional chart abstraction study of patients with HIV enrolled in the Philadelphia Medical Monitoring Project (MMP).PARTICIPANTSMMP participants age 50 and older.MAIN MEASURESCRC screening defined as having a documented colonoscopy, sigmoidoscopy, barium enema, or fecal occult blood test after the age of 50.KEY RESULTSOut of 123 chart abstractions performed, 115 had a complete clinical record from MMP. The majority of the population was male (71.3%), Black/Hispanic (73.8%) and between the age of 50 and 59 (71.3%). 45.2% of patients did not have a PCP. The overall proportion of patients who received CRC screening was 46.9%. Having a documented PCP was the only factor strongly associated with CRC screening. Rates of screening were 66.7% among those with a PCP versus 28.5% among those without a PCP (χ2p< 0.001). After adjusting for race, socioeconomic status, substance and alcohol abuse, the odds of getting CRC screening in those with a PCP was 4.59 (95% CI 2.01-10.48,p< 0.001). The type of practice where patients were enrolled into care was not associated with CRC screening.CONCLUSIONSHaving a PCP significantly increases the likelihood of receiving CRC screening in patients with HIV. Competency in addressing primary care needs in HIV clinics will only become more important as patients with HIV age.