Document Detail

Predictors of colorectal cancer screening from patients enrolled in a managed care health plan.
MedLine Citation:
PMID:  18266204     Owner:  NLM     Status:  MEDLINE    
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>or=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, 2.06-3.96]), 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.
Melissa M Farmer; Roshan Bastani; Lorna Kwan; Michael Belman; Patricia A Ganz
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Cancer     Volume:  112     ISSN:  0008-543X     ISO Abbreviation:  Cancer     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-10     Completed Date:  2008-05-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374236     Medline TA:  Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1230-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2008 American Cancer Society.
Veterans Affairs, Greater Los Angeles Health Services Research and Development Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, California 91343-2036, USA.
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MeSH Terms
Attitude of Health Personnel*
Colorectal Neoplasms / diagnosis*,  epidemiology
Cross-Sectional Studies
Health Care Surveys
Health Knowledge, Attitudes, Practice
Managed Care Programs / statistics & numerical data*
Middle Aged
Physician's Practice Patterns
Risk Assessment
Grant Support

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