Are Physicians' Recommendations For Colorectal Cancer Screening Guideline-Consistent?
Are Physicians' Recommendations For Colorectal Cancer Screening Guideline-Consistent?
复制标题
DOI：
10.1007/s11606-010-1516-5
复制
发表时间：
2011-02-01
影响因子：
5.7
通讯作者：
Taplin, Stephen
中科院分区：
文献类型：
--
作者：
Yabroff, K. Robin;Klabunde, Carrie N.;Taplin, Stephen
背景：美国许多老年人没有接受适当的结直肠癌(CRC)筛查。尽管初级保健医生对患者的建议是筛查过程的核心，但关于他们关于结直肠癌筛查模式菜单指南的建议的信息很少，包括粪便潜血测试(FOBT)、柔性乙状结肠镜(FS)、结肠镜检查和双对比钡灌肠(DCBE)。这项研究的目的是探索与指南一致的结直肠癌筛查模式菜单建议相关的潜在的可修改的医生和实践因素。方法：我们检查了2007年调查的1266名美国具有全国代表性的医生样本的数据。这项调查包括关于医生和执业特点的问题，对筛查的看法，以及在中等风险成年人中对FOBT、FS、结肠镜和DCBE开始年龄和筛查间隔的建议。医生的筛查建议被归类为与推荐的所有、部分或无CRC筛查方式一致的指南。分析使用描述性统计和多分类Logit回归模型。结果：很少有医生(19.1%；95%可信区间：16.9%，21.5%)在他们推荐的所有结直肠癌筛查方法中提出与指南一致的建议。在多因素分析中，较年轻的医生年龄、委员会认证、中北部地理区域、单一专科或多专科执业类型、每周患者较少、推荐的医疗方式较多、使用电子病历、患者对筛查偏好的影响较大以及已发表的临床证据与指南一致性筛查建议相关(p
BACKGROUND: Many older adults in the U. S. do not receive appropriate colorectal cancer (CRC) screening. Although primary care physicians' recommendations to their patients are central to the screening process, little information is available about their recommendations in relation to guidelines for the menu of CRC screening modalities, including fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), colonoscopy, and double contrast barium enema (DCBE). The objective of this study was to explore potentially modifiable physician and practice factors associated with guideline- consistent recommendations for the menu of CRC screening modalities.METHODS: We examined data from a nationally representative sample of 1266 physicians in the U. S. surveyed in 2007. The survey included questions about physician and practice characteristics, perceptions about screening, and recommendations for age of initiation and screening interval for FOBT, FS, colonoscopy and DCBE in average risk adults. Physicians' screening recommendations were classified as guideline consistent for all, some, or none of the CRC screening modalities recommended. Analyses used descriptive statistics and polytomous logit regression models.RESULTS: Few (19.1%; 95% CI: 16.9%, 21.5%) physicians made guideline-consistent recommendations across all CRC screening modalities that they recommended. Inmultivariate analysis, younger physician age, board certification, north central geographic region, single specialty or multi-specialty practice type, fewer patients perweek, higher number of recommended modalities, use of electronic medical records, greater influence of patient preferences for screening, and published clinical evidence were associated with guideline-consistent screening recommendations (p