Challenges in the Management of Positive Fecal Occult Blood Tests
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Many patients with a positive fecal occult blood test (FOBT) do not undergo follow-up evaluations.
To identify the rate of follow-up colonoscopy following a positive FOBT and determine underlying reasons for lack of follow-up.
It is a retrospective chart review.
The subject group consisted of 1,041 adults with positive FOBTs within a large physician group practice from 2004 to 2006.
We collected data on reasons for ordering FOBT, presence of prior colonoscopy, completed evaluations, and results of follow-up tests. We fit a multivariable logistic regression model to identify predictors of undergoing follow-up colonoscopy.
Most positive FOBTs were ordered for routine colorectal cancer screening (76%), or evaluation of anemia (13%) or rectal bleeding (7%). Colonoscopy was completed in 62% of cases, with one-third of these procedures identifying a colorectal adenoma (29%) or cancer (4%). Factors associated with higher rates of follow-up colonoscopy included obtaining the FOBT for routine colorectal screening (odds ratio (OR) 1.59, 95% confidence interval (CI) 1.11–2.29) and consultation with gastroenterology (OR 1.99, 95% CI 1.46–2.72). Patients were less likely to undergo colonoscopy if they were older than 80 years old (OR 0.54, 95% CI 0.31–0.92), younger than 50 years old (OR 0.44, 95% CI 0.28–0.70), uninsured (OR 0.50, 95% CI 0.27–0.93), or had undergone colonoscopy within the prior five years (OR 0.32, 95% CI 0.23–0.44).
Clinical decisions and patient factors available at the time of ordering an FOBT impact performance of colonoscopy. Targeting physicians’ understanding of the use of this test may improve follow-up and reduce inappropriate use of this test.
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- Challenges in the Management of Positive Fecal Occult Blood Tests
Journal of General Internal Medicine
Volume 24, Issue 3 , pp 356-360
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- colorectal cancer
- cancer screening
- quality of care
- risk management
- patient safety
- fecal occult blood test
- Industry Sectors
- Author Affiliations
- 1. Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
- 2. Harvard Vanguard Medical Associates, Boston, MA, USA
- 3. Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA
- 4. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA