Document Detail

Screening for Abdominal Aortic Aneurysms in Outpatient Primary Care Clinics.
MedLine Citation:
PMID:  25446298     Owner:  NLM     Status:  Publisher    
BACKGROUND: The U.S. Preventive Services Task Force (USPSTF) guidelines recommend one-time abdominal aortic aneurysm ultrasound screening for men aged 65 to 75 years who ever smoked. Reported screening rates have been 13% to 26%, but did not include computed tomography (CT), magnetic resonance imaging (MRI), and non-aortic abdominal ultrasound, which provide adequate visualization of the aorta. The objective of this study was to evaluate rates of screening performed intentionally with ultrasound and incidentally with other abdominal imaging, determine rates of redundant screening and evaluate patient and physician characteristics associated with screening.
METHODS: Cross sectional study of patient encounters in 2007 and 2012 to determine abdominal aortic aneurysm screening trends in primary care practices. Participants included all patients who were seen in a primary care office and were eligible for screening by USPSTF guidelines. The primary outcome was percentage of eligible patients screened for abdominal aortic aneurysm by ultrasound or other abdominal imaging.
RESULTS: There were 15120 patients eligible for screening in 2007 and 22355 in 2012. Screening with ultrasounds increased from 3.6% in 2007 to 9.2% in 2012. Screening with any imaging that included the aorta, increased from 31% in 2007 to 41% in 2012. Of 2595 screening ultrasounds performed in either cohort, 800 (31%) were performed on patients who had already undergone another imaging modality. Of 153 physicians who had > 50 eligible patients, rates of abdominal aortic aneurysm screening ranged from 7.5% to 79% (median=39%, IQR=[31%, 47%]), and rates of ultrasound screening ranged from 0% to 47% (median=6.3%, IQR=3.6%, 11.4%). Physician characteristics positively associated with screened patients included female sex (OR 1.32, 95% CI 1.12, 1.54), specialty (Internal Medicine vs. Family Medicine, (OR 1.32, 95% CI 1.14, 1.54), and location (academic medical center vs. family health center OR 1.30, 95% CI 1.04, 1.62).
CONCLUSIONS: Abdominal aortic aneurysm screening rates remain below 50%, but are improving over time. Screening by individual physicians varied widely indicating substantial opportunity for educational interventions. Most abdominal aortic aneurysm screening is completed incidentally, and some patients later undergo unnecessary ultrasound screening. Before ordering screening, physicians and electronic health record-based reminder tools should ensure that the aorta has not been previously visualized.
Allison L Ruff; Kathryn Teng; Bo Hu; Michael B Rothberg
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-13
Journal Detail:
Title:  The American journal of medicine     Volume:  -     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-12-2     Completed Date:  -     Revised Date:  2014-12-3    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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