Colorectal cancer testing among patients cared for by Iowa family physicians
Colorectal cancer testing among patients cared for by Iowa family physicians
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DOI：
10.1016/j.amepre.2006.04.008
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发表时间：
2006-09-01
影响因子：
5.5
通讯作者：
James, Paul A.
中科院分区：
文献类型：
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作者：
Levy, Barcey T.;Dawson, Jeffrey;James, Paul A.
背景：结直肠癌（CRC）在很大程度上可以预防或有效治疗，但大约一半的合格美国人没有接受筛查。本研究的目的是检查患者和医生的因素与记录CRC testing根据国家guidelines.Methods：横断面研究，其中511随机选择的农村患者年龄在55至80岁的16个委员会认证的爱荷华州家庭医生在2004年入组。患者调查和病历信息与医生调查相关联。CRC测试的预测因素进行了检查，采用回归程序，容纳随机医生的影响（2005-2006）。结果：46%的患者是最新的CRC测试按照国家指导方针。医生的百分比从5%到75%不等（p < 0.0001）。在最新的患者中，89%进行了结肠镜检查，62%在测试之前有可能表明CRC的症状。除症状外，最强的单变量预测因子是患者对医生建议的回忆（比值比[OR]=6.4，95%置信区间[01=4.2-9.6]）和医生建议的记录（OR= 14.1，CI=8.5-23.3）。一个多变量回归模型显示，政府保险显著增加了按照指南进行的测试（OR= 1.6，0 =1.2-2.3），过去26个月内有过健康维护访视（OR=2.4，CI=1.4-4.1），CRC家族史（OR=3.1，CI=1.6-5.8），疾病数量（每种额外疾病的OR=1.2，0=11-1.3），筛查对患者的重要性很高（OR=2.6，CI=1.5-4.5），患者对医生讨论的满意度（OR=3.3，CI=2.2-4.8），接受过软式乙状结肠镜检查培训的医生（OR=2.3，CI=1.6-3.4），医生报告试图遵循美国癌症协会（ACS）指南（OR= 1.7，CI=1.2-2.5）。排除患者谁有症状的筛选前，大多数的OR在logistic回归分析增加，除了医疗条件和医生试图遵循ACS guidelines becomes nonsignificant.Conclusions：不到一半的农村患者接受CRC检测，大多数的测试有症状。医生的建议和提出建议的方式极大地影响了患者是否接受测试。
Background: Colorectal cancer (CRC) can be largely prevented or effectively treated, yet about half of eligible Americans have not been screened. The purpose of this study was to examine patient and physician factors associated with documented CRC testing according to national guidelines.Methods: Cross-sectional study where 511 randomly selected rural patients aged 55 to 80 years of 16 board-certified Iowa family physicians were enrolled in 2004. Patient survey and medical record information were linked with physician surveys. Predictors of CRC testing were examined using a regression procedure that accommodated random physician effects (2005-2006).Results: Forty six percent of patients were up-to-date with CRC testing in accordance with national guidelines. This percentage varied from 5% to 75% by physician (p < 0.0001). Of the patients who were up-to-date, 89% had colonoscopy, and 62% had symptoms prior to testing that could indicate CRC. The strongest univariate predictors other than symptoms were patient recollection of physician recommendation (odds ratio [OR]=6.4, 95% confidence interval [01=4.2-9.6) and physician documentation of recommendation (OR= 14.1, CI=8.5-23.3). A multivariable regression model showed testing in accordance with guidelines significantly increased with government insurance (OR=1.6,0=1.2-2.3), having a health maintenance visit in the preceding 26 months (OR=2.4, CI=1.4-4.1), family history of CRC (OR=3.1, CI=1.6-5.8), number of medical conditions (OR=1.2 for each additional condition, 0=11-1.3), high importance of screening to patient (OR=2.6, CI=1.5-4.5), patient satisfaction with doctor's discussions (OR=3.3, CI=2.2-4.8), physician trained in flexible sigmoidoscopy (OR=2.3, CI=1.6-3.4), and physician report of trying to follow American Cancer Society (ACS) guidelines (OR= 1.7, CI=1.2-2.5). After excluding patients who had symptoms prior to screening, most of the ORs in the logistic regression analysis increased except that the number of medical conditions and physician trying to follow ACS guidelines became nonsignificant.Conclusions: Fewer than half of rural patients received CRC testing, and most of those tested had symptoms. Physician recommendations and the manner of presenting the recommendations greatly influenced whether patients were tested.