Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test

Barbara Turner, Ronald E. Myers, Terry Hyslop, Walter W. Hauck, David Weinberg, Timothy Brigham, James Grana, Todd Rothermel, Neil Schlackman

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)357-363
Number of pages7
JournalJournal of General Internal Medicine
Volume18
Issue number5
DOIs
StatePublished - May 1 2003

Keywords

  • Attitude of health personnel
  • Colorectal neoplasms
  • Mass screening
  • Occult blood
  • Primary health care

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint Dive into the research topics of 'Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test'. Together they form a unique fingerprint.

Cite this