Predictors of colorectal cancer screening from patients enrolled in a managed care health plan
Predictors of colorectal cancer screening from patients enrolled in a managed care health plan
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DOI：
10.1002/cncr.23290
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发表时间：
2008-03-15
期刊：
影响因子：
6.2
通讯作者：
Ganz, Patricia A.
中科院分区：
文献类型：
--
作者：
Farmer, Melissa M.;Bastani, Roshan;Ganz, Patricia A.
背景资料。尽管人们越来越认识到结直肠癌(CRC)筛查在降低癌症死亡率方面的重要性，但全国的筛查率很低，这表明迫切需要了解CRC筛查测试未得到充分利用的障碍和补救措施。方法：使用在2000年之前(2000年；n=498)和2003年(2003年；N=482)作为大型管理型医疗保健计划中结直肠癌筛查的质量改进干预措施，从患者的角度研究了粪便潜血试验(FOBT)和/或内窥镜(柔性乙状结肠镜/结肠镜)筛查结直肠癌的趋势和预测因素。结果：2000年，患者报告的筛查率在指南范围内的任何一项检查均为38%，内窥镜检查为23%，FOBT为22%。2003年，任何检查的筛查率增加到50%，内窥镜检查增加到39%，FOBT增加到24%。与医生讨论过结直肠癌后，筛查的几率显著增加(FOBT：优势比[OR]，2.09[95%可信区间(95%CI)，1.47-2.96]；内窥镜检查：OR，2.33[95%CI，1.67-3.26]；任何检查：OR：2.86[95%CI，2.06-3.961])，报告结直肠癌的障碍总体上降低了筛查的几率(FOBT：OR，0.76[95%CI，0.60-0.95]；内窥镜检查：OR为0.74[95%CI，0.60-0.92]；任何检查：OR为0.66[95%CI，0.54-0.80]。结论：尽管筛查率在3年期间有所增加，但仍有证据表明结直肠癌筛查仍未得到充分利用。获得结直肠癌筛查的两个最强烈的决定因素是提供者的影响和与结直肠癌筛查相关的患者障碍，这表明需要针对提供者和患者的多层次干预。
BACKGROUND. Despite the growing recognition of the importance of colorectal cancer (CRC) screening in reducing cancer mortality, national screening rates are low, indicating a critical need to understand the barriers and remedies for underutilization of CRC screening tests.METHODS. Using results from independent cross-sectional telephone surveys with patients aged >= 50 years performed before (2000; n = 498) and after (2003; n = 482) a quality improvement intervention for CRC screening within a large managed care health plan, the trends and predictors of CRC screening with fecal occult blood test (FOBT) and/or endoscopy (flexible sigmoidoscopy/colonoscopy) were examined from a patient perspective.RESULTS. In 2000, patient reported screening rates within guidelines were 38% for any test, 23% for endoscopy, and 22% for FOBT. In 2003, screening rates increased to 50% for any test, 39% for endoscopy, and 24% for FOBT. Having discussed CRC with a doctor significantly increased the odds of being screened (FOBT: odds ratio [OR], 2.09 [95% confidence interval (95% CI), 1.47-2.96]; endoscopy: OR, 2.33 [95% CI, 1.67-3.26]; and any test: OR, 2.86 [95% CI, 2.06-3.961]), and reporting barriers to CRC in general decreased the odds of being screened (FOBT: OR, 0.76 [95% CI, 0.60-0.95]; endoscopy: OR, 0.74 [95% CI, 0.60-0.92]; and any test: OR, 0.66 [95% CI, 0.54-0.80]).CONCLUSIONS. Although screening rates increased over the 3-year period, evidence was found of ongoing underutilization of CRC screening. The 2 strongest determinants of obtaining CRC screening were provider influence and patient barriers related to CRC screening in general, pointing to the need for multilevel interventions that target both the provider and patient.