Physician and Patient Factors Associated with Ordering a Colon Evaluation After a Positive Fecal Occult Blood Test

• Published in: Journal of general internal medicine : JGIM 2003-05, Vol.18 (5), p.357-363
• Main Authors: Turner, Barbara, Myers, Ronald E., Hyslop, Terry, Hauck, Walter W., Weinberg, David, Brigham, Timothy, Grana, James, Rothermel, Todd, Schlackman, Neil
• Format: Article
• Language: English
• Subjects: Adult; Aged; Algorithms; Attitude of Health Personnel; Barium Sulfate; Biological and medical sciences; Blood tests; Colonoscopy - methods; Colorectal cancer; colorectal neoplasms; Colorectal Neoplasms - complications; Colorectal Neoplasms - diagnosis; Digestive system; Enema; Feces; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - etiology; Humans; Internal medicine; Investigative techniques, diagnostic techniques (general aspects); Male; Mass Screening; Medical sciences; Medical screening; Middle Aged; Occult Blood; Original; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patients; Physicians; Physicians, Family - psychology; Primary care; primary health care; Professional Practice; Sex Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1046/j.1525-1497.2003.20525.x

OBJECTIVE: Successful colorectal cancer screening relies in part on physicians ordering a complete diagnostic evaluation of the colon (CDE) with colonoscopy or barium enema plus sigmoidoscopy after a positive screening fecal occult blood test (FOBT). DESIGN: We surveyed primary care physicians about colorectal cancer screening practices, beliefs, and intentions. At least 1 physician responded in 318 of 413 (77%) primary care practices that were affiliated with a managed care organization offering a mailed FOBT program for patients aged ≥50 years. Of these 318 practices, 212 (67%) had 602 FOBT+ patients from August through November 1998. We studied 184 (87%) of these 212 practices with 490 FOBT+ patients after excluding those judged ineligible for a CDE or without demographic data. Three months after notification of the FOBT+ result, physicians were asked on audit forms if they had ordered CDEs for study patients. Patient‐ and physician‐predictors of ordering CDEs were identified using logistic regression. MEASUREMENTS AND MAIN RESULTS: A CDE was ordered for only 69.5% of 490 FOBT+ patients. After adjustment, women were less likely to have had CDE initiated than men (adjusted odds, 0.66; confidence interval, 0.44 to 0.97). Physician survey responses indicating intermediate or high intention to evaluate a FOBT+ patient with a CDE were associated with nearly 2‐fold greater adjusted odds of actually initiating a CDE in this circumstance versus physicians with a low intention. CONCLUSIONS: Primary care physicians often fail to order CDE for FOBT+ patients. A CDE was less likely to be ordered for women and was influenced by physician's beliefs about CDEs.