Barriers to colorectal cancer screening in rural primary care
Barriers to colorectal cancer screening in rural primary care
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DOI：
10.1016/j.ypmed.2003.11.001
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发表时间：
2004-03-01
影响因子：
5.1
通讯作者：
Ellerbeck, EF
中科院分区：
文献类型：
--
作者：
Greiner, KA;Engelman, KK;Ellerbeck, EF
背景。农村社区居民在获得结直肠癌（CRC）筛查方面可能面临独特的障碍，包括获得服务的机会减少。本研究评估了患者、医生和实践特征对农村初级保健患者接受结直肠癌筛查的影响。我们调查了50岁以上的患者（N= 801）和农村的初级保健医生（N= 36）。医学生进行调查，以评估患者的人口统计学特征、自我报告的CRC筛查、实践特点、当地内窥镜检查的可用性以及医生筛查测试的偏好。我们使用多变量逻辑回归分析来调查自变量之间的关联，以及(1)患者CRC筛查状况和(2)医生和患者之间对CRC讨论的充分性。57%的患者报告说他们接受了最新的结直肠癌筛查，其中大多数人接受了FOBT和内窥镜检查。少数患者（39%）报告有足够的时间讨论CRC筛查，在多变量分析中，这与最新的CRC筛查呈正相关。58%的诊所提供内窥镜检查，44%的诊所至少每月提供一次当地胃肠病学家的检查。内窥镜手术和胃肠病学服务的可用性与CRC筛查或使用内窥镜作为筛查方法无关。农村初级保健患者的CRC筛查与医生CRC筛查讨论的充分性有关，但与内窥镜检查程序无关。改善结直肠癌筛查的努力应侧重于改善对结直肠癌的医患讨论。(C) 2003癌症预防研究所和爱思唯尔公司。版权所有。
Background. Residents of rural communities may face unique barriers to obtaining colorectal cancer (CRC) screening, including reduced access to services. This study assessed the impact of patient, physician, and practice characteristics on rural primary care patient receipt of CRC screening.Methods. We surveyed patients (N= 801) over 50 years of age and primary care physicians (N= 36) in rural practices. Medical students administered surveys to assess patient demographics, self-reported CRC screening, practice features, local availability of endoscopy, and physician screening test preferences. We used multivariable logistic regression analyses to investigate associations between independent variables, and (1) patient CRC screening status and (2) adequacy of CRC discussions between physicians and patients.Results. Fifty-seven percent of patients reported being up-to-date with colorectal cancer screening and most in this group had received FOBT and endoscopy. A minority of patients (39%) reported adequate time to discuss CRC screening, and this was positively associated with being up-to-date with CRC screening in a multivariable analysis. Endoscopy was available in 58% of the practices and 44% of the practices had local gastroenterologists available on at least a monthly basis. The availability of endoscopic procedures and gastroenterological services were not associated with CRC screening or with use of endoscopy as a screening method.Conclusions. CRC screening among rural primary care patients is related to adequacy of physician CRC screening discussions but not access to endoscopic procedures. Efforts to improve CRC screening should focus on improving physician-patient discussions of CRC. (C) 2003 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.